Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery

Bentala, Mohamed; Heuts, Samuel; Vos, Rein; Maessen, Jos G.; Scohy, Thierry V.; Gerritse, Bastiaan M.; Nia, Peyman Sardari

doi:10.1093/icvts/ivv160

Cited by 25 publications

(27 citation statements)

References 18 publications

(27 reference statements)

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“…Murzi and colleagues [33] further proposed CO 2 insufflation in the surgical field to reduce the amount of intracardiac air, and retaining the aortic root vent in place until the heart is fully beating and no more bubbles are seen on transesophageal echocardiography. Cooling to 30 C, the use of cerebral oximetry to detect cerebral ischemia and the strict manipulation of the guidewire and the EABO only during antegrade flow may also contribute to lower rates of adverse events [25].…”

Section: Commentmentioning

confidence: 99%

Clinical Safety and Effectiveness of Endoaortic as Compared to Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery: Meta-Analysis of Observational Studies

Kowalewski

Malvindi

Suwalski³

et al. 2017

The Annals of Thoracic Surgery

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Controversies remain on the increased rate of neurological events after small thoracotomy mitral valve surgery attributed to endoaortic balloon occlusion (EABO). Systematic literature search of databases identified 17 studies enrolling 6,643 patients comparing safety and effectiveness of EABO versus transthoracic clamp. In a meta-analysis, there was no difference in occurrence of cerebrovascular events, all-cause mortality, and kidney injury. EABO was associated with a significantly higher risk of iatrogenic aortic dissection (0.93% versus 0.13%; risk ratio, 4.67; 95% confidence interval, 1.62 to 13.49; p = 0.004) and a trend toward longer operative times. The data is limited to observational studies.

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Section: Commentmentioning

confidence: 99%

Clinical Safety and Effectiveness of Endoaortic as Compared to Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery: Meta-Analysis of Observational Studies

Kowalewski

Malvindi

Suwalski³

et al. 2017

The Annals of Thoracic Surgery

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“…Additionally, early publications indicated that endoaortic occlusion may be technically difficult to achieve. The potential for aortic dissection related to endoaortic occlusion was also raised early in the minimally invasive port-access experience, but more recent studies and large single center reviews demonstrate that this technique is quite safe in the hands of experienced surgeons [7,14,15]. Operating room times may also be a feared source of increased costs, and minimally invasive approaches consistently report significantly longer cardiopulmonary bypass and cross-clamp times.…”

Section: Commentmentioning

confidence: 99%

Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes Without Increased Cost: A Multi-Institutional Analysis

Downs

Johnston

LaPar

et al. 2016

The Annals of Thoracic Surgery

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Background Minimally invasive mitral valve surgery (mini-MVR) has grown in popularity. Although single centers have reported excellent outcomes, there is limited data on real world outcomes and costs of mini-MVR. Moreover, mini-MVR has been criticized as adding additional cost without clear benefit. We hypothesized that mini-MVR provides superior outcomes with incremental increased costs in a multi-institutional cohort. Methods Records for patients undergoing mitral valve surgery with or without atrial ablation from 2011-2014 were extracted from a multi-institutional, regional Society of Thoracic Surgeons database and stratified according to right chest approach/ minimally invasive or conventional sternotomy. Patients undergoing CABG or other concomitant procedures were excluded. Patients undergoing isolated mitral surgery were propensity matched based on factors including age, comorbidities, and preoperative laboratory values; clinical outcomes and cost differences were assessed by approach. Results A total of 1304 patients underwent mitral surgery, including 425 (32.6%) via minimally invasive approach. In the propensity-matched analysis (n=355 per group), mini-MVR patients had similar rates of mortality, stroke, and other complications compared to conventional MVR. Meanwhile, mini-MVR patients experienced shorter ICU and hospital lengths of stay, as well as fewer transfusions. Importantly, total hospital costs were no different between the two matched groups. Conclusions Compared to conventional sternotomy, mini-MVR in the “real world” demonstrated no differences in major morbidity, but was associated with shorter length of stay and fewer transfusions. Contrary to our hypothesis, mini-MVR can be performed with similar total hospital costs as conventional sternotomy. In summary, minimally invasive mitral surgery in select patients can provide superior outcomes without increased cost.

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“…However, surgeon preference usually determines their use. 2,3,[22][23][24] The IntraClude® balloon clamp (Edwards Lifesciences, Irvine, CA) allows end clamping of the aorta and is useful in redo cases. It is inserted from the femoral artery and requires TEE and frequently fluoroscopic guidance.…”

Section: Myocardial Protection and Cardioplegia Administrationmentioning

confidence: 99%

“…It is inserted from the femoral artery and requires TEE and frequently fluoroscopic guidance. 2,3,[22][23][24] Antegrade cardioplegia and venting of the aortic root is performed from the tip of the cannula. This clamp may not be used in the presence of aortoiliac disease.…”

Section: Myocardial Protection and Cardioplegia Administrationmentioning

confidence: 99%

“…Some studies have shown an increased stroke rate with this technique, and balloon rupture during cardioplegic arrest can lead to complications. 2,3,[22][23][24] Conventional cardioplegia is used by most surgeons. 2,3 Induction is usually achieved with an antegrade dose except when significant aortic regurgitation or coronary artery disease (especially left main artery) are present.…”

Section: Myocardial Protection and Cardioplegia Administrationmentioning

confidence: 99%

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Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

Ramchandani

Jabbari

Saleh

et al. 2016

Methodist DeBakey Cardiovascular Journal

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For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs-the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation.

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Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery

Cited by 25 publications

References 18 publications

Clinical Safety and Effectiveness of Endoaortic as Compared to Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery: Meta-Analysis of Observational Studies

Clinical Safety and Effectiveness of Endoaortic as Compared to Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery: Meta-Analysis of Observational Studies

Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes Without Increased Cost: A Multi-Institutional Analysis

Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

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