Filip Casselman1, Jose Aramendi2, Mohamed Bentala3, Pascal Candolfi4, Rudolf Coppoolse5, Borut Gersak6, Ernesto Greco7, Paul Herijgers8, Steven Hunter9, Ralf Krakor10, Mauro Rinaldi11, Frank Van Praet12, Geert Van Vaerenbergh12, Joseph Zacharias13. 1. Department of Cardiovascular & Thoracic Surgery, OLV, Aalst, Belgium. Electronic address: filip.casselman@olvz-aalst.be. 2. Department of Cardiac Surgery, Hospital de Cruces, Bilbao, Spain. 3. Department of Cardiothoracic Surgery, Amphia Breda Hospital, Breda, The Netherlands. 4. Biostatistics, Edwards Lifesciences, Nyon, Switzerland. 5. Department of Cardiac Surgery, Schûchtermann Klinik, Bad Rothenfelde, Germany. 6. Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia. 7. Department of Cardiac Surgery, Policlinico Umberto I, Rome, Italy. 8. Department of Cardiac Surgery, Gasthuisberg, Leuven, Belgium. 9. Department of Cardiac Surgery, Northern General Hospital, Sheffield, United Kingdom. 10. Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany. 11. Department of Cardiac Surgery, Azienda Ospedaliera San Giovanni Battista, Turin, Italy. 12. Department of Cardiovascular & Thoracic Surgery, OLV, Aalst, Belgium. 13. Department of Cardiac Surgery, Victoria Hospital, Blackpool, United Kingdom.
Abstract
BACKGROUND: Some controversy exists regarding the safety of endoaortic balloon clamping in minimal access isolated mitral valve surgery (MIMVS). The aim of this European multicenter study was to analyze the results in 10 experienced centers and compare the outcomes with published data. METHODS: The most recent 50 consecutive MIMVS cases from 10 European surgeons who had performed at least 100 procedures were prospectively collected and retrospectively analyzed. All procedures were performed through right minithoracotomy with femoral cannulation and endoaortic balloon occlusion. In-hospital and 30-day outcomes were studied. Mortality and stroke rates were compared with published median sternotomy and MIMVS outcomes. RESULTS: Mean age was 63.2 ± 12.5 years, 289 (57.8%) were male, mean logistic European system for cardiac operative risk evaluation was 6.1 ± 6.2, and 53 (10.6%) procedures had cardiac reoperations. Concomitant procedures were performed in 126 (25.9%) cases. Three patients (0.6%) required conversion to full sternotomy. Ten patients (2.0%) necessitated endoaortic balloon clamping conversion (8 to external clamping), and re-exploration for bleeding was necessary in 24 (4.8%) cases. Mean aortic cross-clamp and cardiopulmonary bypass times were 85.6 ± 30.1 and 129.5 ± 40.2 min, respectively, and were significantly longer for concomitant procedures (p < 0.001). There were no aortic dissections and no deep venous thromboses. Operative mortality (none neurologic) and major stroke occurred in 7 (1.4%) and 4 (0.8%) patients, respectively. These rates compared favorably with the published literature on isolated primary mitral valve surgery (MVS) through sternotomy or minithoracotomy (mortality rates 0.2% to 11.6%, stroke rates 0.6% to 4.4%). CONCLUSIONS: Once procedural proficiency is acquired, endoaortic balloon clamping in MIMVS is a safe and effective technique. Despite the fact that this patient cohort also includes combined and redo procedures, the observed mortality and stroke rate compared favorably with the existing literature on primary isolated mitral valve surgery irrespective of the approach.
BACKGROUND: Some controversy exists regarding the safety of endoaortic balloon clamping in minimal access isolated mitral valve surgery (MIMVS). The aim of this European multicenter study was to analyze the results in 10 experienced centers and compare the outcomes with published data. METHODS: The most recent 50 consecutive MIMVS cases from 10 European surgeons who had performed at least 100 procedures were prospectively collected and retrospectively analyzed. All procedures were performed through right minithoracotomy with femoral cannulation and endoaortic balloon occlusion. In-hospital and 30-day outcomes were studied. Mortality and stroke rates were compared with published median sternotomy and MIMVS outcomes. RESULTS: Mean age was 63.2 ± 12.5 years, 289 (57.8%) were male, mean logistic European system for cardiac operative risk evaluation was 6.1 ± 6.2, and 53 (10.6%) procedures had cardiac reoperations. Concomitant procedures were performed in 126 (25.9%) cases. Three patients (0.6%) required conversion to full sternotomy. Ten patients (2.0%) necessitated endoaortic balloon clamping conversion (8 to external clamping), and re-exploration for bleeding was necessary in 24 (4.8%) cases. Mean aortic cross-clamp and cardiopulmonary bypass times were 85.6 ± 30.1 and 129.5 ± 40.2 min, respectively, and were significantly longer for concomitant procedures (p < 0.001). There were no aortic dissections and no deep venous thromboses. Operative mortality (none neurologic) and major stroke occurred in 7 (1.4%) and 4 (0.8%) patients, respectively. These rates compared favorably with the published literature on isolated primary mitral valve surgery (MVS) through sternotomy or minithoracotomy (mortality rates 0.2% to 11.6%, stroke rates 0.6% to 4.4%). CONCLUSIONS: Once procedural proficiency is acquired, endoaortic balloon clamping in MIMVS is a safe and effective technique. Despite the fact that this patient cohort also includes combined and redo procedures, the observed mortality and stroke rate compared favorably with the existing literature on primary isolated mitral valve surgery irrespective of the approach.
Authors: Francesco G Irace; David Rose; Riccardo D'Ascoli; Federica Caldaroni; Ines Andriani; Fernando Piscioneri; Piergiusto Vitulli; Matteo Piattoli; Luigi Tritapepe; Ernesto Greco Journal: J Vis Surg Date: 2015-10-28
Authors: Mattia Vinciguerra; Francesco Grigioni; Silvia Romiti; Giovanni Benfari; David Rose; Cristiano Spadaccio; Sara Cimino; Antonio De Bellis; Ernesto Greco Journal: Biomedicines Date: 2021-04-21