Key result
The endo-aortic balloon showed no significant differences in cardiopulmonary bypass or cross-clamp times compared to the external aortic clamp, but resulted in lower troponin T levels (P=0.014).
Why the study?
Does the endo-aortic balloon improve perioperative outcomes compared to the external aortic clamp in patients undergoing minimally invasive mitral valve surgery?
Cohort (n=221)
No
Does the endo-aortic balloon improve perioperative outcomes compared to the external aortic clamp in patients undergoing minimally invasive mitral valve surgery?
The endo-aortic balloon and external aortic clamp offer similar cross-clamp and CPB times during minimally invasive mitral valve surgery, though the balloon may be associated with less myocardial damage and shorter hospital stays despite a 6% conversion rate.
Endo-aortic balloon may be associated with less myocardial injury in observational data; leaves open whether it improves outcomes versus external clamp in randomized trials.
OBJECTIVES: The aim of this study was to assess the differences in perioperative outcomes and complications between the endo-aortic balloon (EAB) and the external aortic clamp (EAC) during primary elective minimally invasive mitral valve surgery (MIMVS) in a single referral centre by one surgeon. Primary outcomes were cardiopulmonary bypass time (CPB), cross-clamp time (CX) and occurrence of postoperative cerebrovascular accidents (CVAs). Secondary outcomes were other perioperative parameters and complications. METHODS: We retrospectively analysed 340 consecutive patients who underwent MIMVS for mitral regurgitation (MR), mitral stenosis or combined regurgitation/stenosis between November 2010 and March 2014 in a single referral centre. In total, 221 patients who underwent an isolated mitral valve repair or isolated mitral valve replacement or repair/replacement combined with an atrial fibrillation (AF)-ablation procedure were included. Patients who had previous cardiac surgery or concomitant tricuspid valve surgery, myxoma or atrial septal defect closure surgery were excluded. RESULTS: A total of 57 patients (Group A) underwent MIMVS using the EAC and 164 patients (Group B) were operated using an EAB. Preoperative variables showed a significant difference in poor left ventricular function (LVF, P = 0.18) and moderate LVF (P = 0.019). No significant differences were found in CPB-time, cross-clamp time or postoperative CVA. Furthermore, no significant differences were found in complications, 30-day mortality or postoperative echocardiographical MR gradation. Hospital stay, however, was prolonged in Group A (P = 0.001) and maximum troponin T levels were significantly lower in Group B (P = 0.014). In Group B however, 10 procedures were converted (6%) from EAB to EAC. CONCLUSIONS: There is no difference in use between the EAB and the EAC in terms of CPB-time and cross-clamp time, complications or MR gradation at discharge. Use of the EAC showed significantly higher postoperative levels of troponin T, implying more myocardial damage, compared with the EAB. In 6% of the cases however, patients were converted from the EAB to the EAC.
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Bentala et al. (2015) conducted a cohort in Mitral regurgitation, mitral stenosis or combined regurgitation/stenosis (n=221). Endo-aortic balloon vs. External aortic clamp was evaluated on Cardiopulmonary bypass time, cross-clamp time, and occurrence of postoperative cerebrovascular accidents. The endo-aortic balloon showed no significant differences in cardiopulmonary bypass or cross-clamp times compared to the external aortic clamp, but resulted in lower troponin T levels (P=0.014).
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