title: Port access cardiac operations can be safely performed with either endoaortic balloon or Chitwood clamp.
abstract: BACKGROUND
  Minimally invasive, right thoracotomy (port access) approaches to intracardiac operations (mitral valve, tricuspid valve, atrial septal defect, intracardiac tumors) are becoming increasingly accepted by surgeons, cardiologists, and patients alike. Standard techniques for cardioplegic arrest of the heart have included endoaortic balloons and Chitwood clamps. Concerns have been raised regarding the potential increased risk of vascular adverse events (embolization, dissection, stroke, lower extremity ischemia) associated with endoaortic balloon occlusion. We undertook this study to evaluate the vascular risk associated with endoaortic balloon use.
  
  
  METHODS
  All patients undergoing minimally invasive, port access, right thoracotomy operations from 1998 to 2012 at our institution were retrospectively analyzed. Patients undergoing aortic occlusion with the Chitwood clamp (n=189) were compared with patients undergoing occlusion with the endoaortic balloon (n=875).
  
  
  RESULTS
  There was no statistical difference in the rate of dissection between patients undergoing aortic occlusion with an endoaortic balloon (1.03%) and those receiving a Chitwood clamp (1.06%). Similarly, there was no difference in the rate of type A dissection between aortic occlusion strategies (endoaortic balloon=0.57%, n=5, vs Chitwood clamp=1.06%, n=2, p=0.28). No difference in the incidence of stroke was identified between the endoaortic balloon and the Chitwood clamp (2.2% vs 2.1%, p=1.0).
  
  
  CONCLUSIONS
  Minimally invasive cardiac operations using a peripheral cannulation strategy can be safely performed with minimal vascular adverse events incorporating either endoaortic balloon or Chitwood clamp aortic occlusion. As experience with the endoaortic balloon is gained, the incidence of vascular adverse events can be reduced to nearly negligible rates.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Goldstone
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Fox
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: clark.hargrove@uphs.upenn.edu.
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
mesh_terms: D000792:Angiography; D001013:Aorta, Thoracic; D021721:Balloon Occlusion / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D015996:Survival Rate / Q000639:trends; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome