title: Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery.
abstract: OBJECTIVE
  The aim of this study was to assess the differences in perioperative outcomes and complications between the endo-aortic balloon (EAB) and the external aortic clamp (EAC) during primary elective minimally invasive mitral valve surgery (MIMVS) in a single referral centre by one surgeon. Primary outcomes were cardiopulmonary bypass time (CPB), cross-clamp time (CX) and occurrence of postoperative cerebrovascular accidents (CVAs). Secondary outcomes were other perioperative parameters and complications.
  
  
  METHODS
  We retrospectively analysed 340 consecutive patients who underwent MIMVS for mitral regurgitation (MR), mitral stenosis or combined regurgitation/stenosis between November 2010 and March 2014 in a single referral centre. In total, 221 patients who underwent an isolated mitral valve repair or isolated mitral valve replacement or repair/replacement combined with an atrial fibrillation (AF)-ablation procedure were included. Patients who had previous cardiac surgery or concomitant tricuspid valve surgery, myxoma or atrial septal defect closure surgery were excluded.
  
  
  RESULTS
  A total of 57 patients (Group A) underwent MIMVS using the EAC and 164 patients (Group B) were operated using an EAB. Preoperative variables showed a significant difference in poor left ventricular function (LVF, P = 0.18) and moderate LVF (P = 0.019). No significant differences were found in CPB-time, cross-clamp time or postoperative CVA. Furthermore, no significant differences were found in complications, 30-day mortality or postoperative echocardiographical MR gradation. Hospital stay, however, was prolonged in Group A (P = 0.001) and maximum troponin T levels were significantly lower in Group B (P = 0.014). In Group B however, 10 procedures were converted (6%) from EAB to EAC.
  
  
  CONCLUSIONS
  There is no difference in use between the EAB and the EAC in terms of CPB-time and cross-clamp time, complications or MR gradation at discharge. Use of the EAC showed significantly higher postoperative levels of troponin T, implying more myocardial damage, compared with the EAB. In 6% of the cases however, patients were converted from the EAB to the EAC.
authors.affiliation: Department of Cardiothoracic Surgery, Amphia Hospital, Breda, Netherlands mbentala@amphia.nl.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bentala
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Samuel
authors.initials: S
authors.lastname: Heuts
authors.affiliation: Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands.
authors.forename: Rein
authors.initials: R
authors.lastname: Vos
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
authors.affiliation: Department of Cardiothoracic Anaesthesia, Amphia Hospital, Breda, Netherlands.
authors.forename: Thierry V
authors.initials: TV
authors.lastname: Scohy
authors.affiliation: Department of Cardiothoracic Anaesthesia, Amphia Hospital, Breda, Netherlands.
authors.forename: Bastiaan M
authors.initials: BM
authors.lastname: Gerritse
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
authors.forename: Peyman
authors.initials: P
authors.lastname: Sardari Nia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments
keywords: Endo-aortic balloon; External aortic clamp; Minimally invasive surgery; Mitral valve