Key result
Combined multimodality monitoring during minimally invasive mitral valve surgery with an intra-aortic occlusion device yielded 0 cases of aortic dissection, neurological damage, or myocardial ischemia.
Why the study?
Minimally invasive right mini-thoracotomy is widely used for mitral valve surgery, but an effective, safe, and reproducible method using an intra-aortic occlusion device needed to be evaluated.
Does a combined monitoring approach using 3D TEE, bilateral arterial pressure, aortic root pressure, and cerebral oximetry ensure safety and efficacy in patients undergoing minimally invasive mitral valve surgery with an intra-aortic occlusion device?
Observational (n=48)
No
Does a combined monitoring approach using 3D TEE, bilateral arterial pressure, aortic root pressure, and cerebral oximetry ensure safety and efficacy in patients undergoing minimally invasive mitral valve surgery with an intra-aortic occlusion device?
A comprehensive multimodality monitoring strategy is safe and effective for preventing and promptly detecting complications during minimally invasive mitral valve surgery using an intra-aortic occlusion device.
Small retrospective series supports feasibility of intra-aortic occlusion for mini-thoracotomy mitral surgery; leaves open prospective validation before broader adoption.
BACKGROUND: Minimally invasive approach through a right mini-thoracotomy is a world-wide used procedure for mitral valve surgery. We performed a retrospective analysis based on our center experience in order to propose an effective, safe and reproducible method using an intra-aortic occlusion device. METHODS: This is a retrospective analysis on 48 consecutive patients undergoing mitral valve surgery through a right anterolateral mini-thoracotomy in our center. An intra-aortic occlusion device was used for aortic clamping and cardioplegia delivery. Simultaneous multi-plane three-dimensional echocardiography imaging was acquired to detect the venous cannulas position, the intra-aortic device location in the ascending aorta, the balloon inflation, the complete occlusion of the aorta, the cardioplegia delivery, the origin and the blood flow in the right coronary artery. Aortic root pressure was measured by the tip of the intra-aortic occlusion device. A bilateral upper extremity invasive arterial pressure monitoring was detected. Neuromonitoring was performed through bilateral cerebral oximetry. RESULTS: The analysis has shown no aortic dissection, neurological damage type 1 and myocardial ischemia in the study population. In 3 cases a distal displacement of the intra-aortic occlusion device was promptly detected by the combined use of echocardiographic imaging and by a drop of the right cerebral oximetry saturation and of the right radial artery pressure. CONCLUSIONS: The combined use of transesophageal simultaneous multi-plane three- dimensional echocardiography imaging, bilateral upper extremity invasive arterial pressure monitoring, aortic root pressure and cerebral oximetry is an effective, safe and reproducible method in patients undergoing minimally invasive valve surgery using an intra-aortic occlusion device.
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Pisano et al. (2021) conducted an observational in Mitral valve surgery (n=48). Combined multimodality monitoring (3D echocardiography, bilateral arterial pressure, aortic root pressure, cerebral oximetry) with an intra-aortic occlusion device was evaluated on Aortic dissection, neurological damage type 1, and myocardial ischemia. Combined multimodality monitoring during minimally invasive mitral valve surgery with an intra-aortic occlusion device yielded 0 cases of aortic dissection, neurological damage, or myocardial ischemia.
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