title: Remote access perfusion for minimally invasive cardiac surgery: to clamp or to inflate?
abstract: OBJECTIVE
  Endoaortic balloon occlusion (EBO) and aortic transthoracic clamping (TTC) are the dominant methods of remote access perfusion (RAP) in minimally invasive cardiac surgery. The aim of the study was to compare the two methods in terms of feasibility, success and complications.
  
  
  METHODS
  From June 2001 to November 2011, 307 (median age; range) (57; 16-77 years) and 460 (62; 11-88 years) patients underwent minimally invasive CABG, ASD and mitral valve surgery using EBO and TTC, respectively. Perioperative procedure feasibility, success and postoperative complications were recorded.
  
  
  RESULTS
  Overall 30-day mortality was 0 and 2 (0.43%) for the EBO and TTC groups, respectively (P = 0.52). Overall and RAP-associated conversions were noted in 21 (6.8%) and 4 (1.3%) patients in the EBO and in 9 (2%) and 6 (1.3%) patients in the TTC groups (P < 0.001, P = 1.00, respectively). Incidence of major complications, including aortic dissection, major vessel perforation, injury of intrapericardial structures, limb ischaemia, myocardial infarction and neurologic events, was similar [EBO: 12 (4%); TTC: 11 (2.4%); P = 0.23]. Minor complications such as minor vessel injury, groin bleeding or lymphatic fistula were noted in 31 (10.1%) and 35 (7.6%), respectively (P = 0.23). Successful RAP procedures defined as absence of RAP-associated conversions and major complications were equal [EBO: 295 (96%); TTC: 449 (97.6%); P = 0.23]. Complications detected during follow-up included pain: 30 of 249 (12%) and 13 of 279 (4.7%) (P = 0.002); sensational disturbances: 60 of 249 (24.1%) and 40 of 278 (14.4%) (P = 0.005) and wound-healing complications: 49 of 249 (19.7%) and 42 of 277 (15.2%) (P = 0.172) for EBO and TTC, respectively.
  
  
  CONCLUSIONS
  RAP can be successfully and safely implemented in minimally invasive cardiac surgery. EBO and transthoracic clamping of the ascending aorta are performing equally in terms of feasibility and procedural success.
authors: Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors: Christoph
authors: C
authors: Krapf
authors: Peter
authors: P
authors: Wohlrab
authors: Sarah
authors: S
authors: Häußinger
authors: Thomas
authors: T
authors: Schachner
authors: Herbert
authors: H
authors: Hangler
authors: Michael
authors: M
authors: Grimm
authors: Ludwig
authors: L
authors: Müller
authors: Johannes
authors: J
authors: Bonatti
authors: Nikolaos
authors: N
authors: Bonaros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D015425:Myocardial Reperfusion / Q000009:adverse effects* / Q000379:methods*; D059035:Perioperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Minimally invasive cardiac surgery; Procedural outcomes; Remote access perfusion