Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 1;24(3):184-190.
doi: 10.2459/JCM.0000000000001404. Epub 2022 Nov 16.

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

Valentina Grazioli  1 , Laura Giroletti  1   2 , Ascanio Graniero  1   2 , Giovanni Albano  3 , Maurizio Mazzoni  3 , Paolo Giovanni Panisi  1 , Piersilvio Gerometta  1 , Amedeo Anselmi  4 , Alfonso Agnino  1   2
Affiliations

Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery

Valentina Grazioli et al. J Cardiovasc Med (Hagerstown). .

Abstract

Aims: Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes.

Methods: We investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables.

Results: The endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block.

Conclusions: In experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.

PubMed Disclaimer

References

    1. Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003; 108: (Suppl 1): II48–II54.
    1. Sakaguchi T. Minimally invasive mitral valve surgery through a right mini-thoracotomy. Gen Thorac Cardiovasc Surg 2016; 64:699–706.
    1. Fann JI, Pompili MF, Stevens JH, Siegel LC, St Goar FG, Burdon TA, et al. Port-access cardiac operations with cardioplegic arrest. Ann Thorac Surg 1997; 63: (Suppl): S35–S39.
    1. Navia JL, Cosgrove DM 3rd. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62:1542–1544.
    1. Chitwood WR Jr, Wixon CL, Elbeery JR, Moran JF, Chapman WH, Lust RM. Video-assisted minimally invasive mitral valve surgery. J Thorac Cardiovasc Surg 1997; 114:773–780. discussion 780–782.

MeSH terms