title: Minimally invasive mitral valve surgery: influence of aortic clamping technique on early outcomes.
abstract: BACKGROUND
  Several methods of aortic clamping have been described for minimally invasive mitral valve surgery (MIMVS). The aim of this study was to compare the endoaortic balloon occlusion technique with the transthoracic clamp approach in terms of perioperative outcomes.
  
  
  METHODS
  Between May 2006 and October 2011, a total of 259 patients underwent MIMVS through a 4 to 5 cm right anterolateral minithoracotomy. In 243 (93.8%) of these, the aorta was clamped using either the endoaortic balloon occlusion technique (endoballoon, n = 140) or the transthoracic clamp technique (transthoracic, n = 103).
  
  
  RESULTS
  Patients in the endoballoon group had significantly longer operating time (4.3 ± 1.0 hours vs 3.2 ± 0.8 hours, p < 0.001), cardiopulmonary bypass time (143 ± 44 minutes vs 111 ± 29 minutes , p < 0.001), and cross-clamp time (114 ± 38 minutes vs 86 ± 23 minutes , p < 0.001). Perioperative blood loss was higher in the endoballoon group (287 ± 239 mL vs 213 ± 189 mL, p = 0.008) as was the mean postoperative creatinine kinase-MB level (36 ± 44 μg/L vs 26 ± 12 μg/L, p = 0.011). The repair rate was 99% or greater in both groups (p = 0.99). All patients left the operating room with no or trivial residual mitral regurgitation on transesophageal echocardiographic evaluation. In the endoballoon group there was 1 stroke (1%) and 5 myocardial infarctions (4%), compared with 2 strokes (2%) in the transthoracic group (p = not significant). There were 4 cases of postoperative cardiogenic shock, all of which occurred in the endoballoon group (p = 0.14). In-hospital mortality occurred in 2 patients from each group (p = 0.99).
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery can be performed successfully using either the endoaortic balloon technique or the transthoracic clamp approach. However, the transthoracic technique results in shorter operation time, less perioperative bleeding and better myocardial protection.
authors.affiliation: Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Lebon
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Dionne
authors.forename: Hugues
authors.initials: H
authors.lastname: Jeanmart
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D021721:Balloon Occlusion / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: 35