title: Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience.
abstract: BACKGROUND
  Some controversy exists regarding the safety of endoaortic balloon clamping in minimal access isolated mitral valve surgery (MIMVS). The aim of this European multicenter study was to analyze the results in 10 experienced centers and compare the outcomes with published data.
  
  
  METHODS
  The most recent 50 consecutive MIMVS cases from 10 European surgeons who had performed at least 100 procedures were prospectively collected and retrospectively analyzed. All procedures were performed through right minithoracotomy with femoral cannulation and endoaortic balloon occlusion. In-hospital and 30-day outcomes were studied. Mortality and stroke rates were compared with published median sternotomy and MIMVS outcomes.
  
  
  RESULTS
  Mean age was 63.2 ± 12.5 years, 289 (57.8%) were male, mean logistic European system for cardiac operative risk evaluation was 6.1 ± 6.2, and 53 (10.6%) procedures had cardiac reoperations. Concomitant procedures were performed in 126 (25.9%) cases. Three patients (0.6%) required conversion to full sternotomy. Ten patients (2.0%) necessitated endoaortic balloon clamping conversion (8 to external clamping), and re-exploration for bleeding was necessary in 24 (4.8%) cases. Mean aortic cross-clamp and cardiopulmonary bypass times were 85.6 ± 30.1 and 129.5 ± 40.2 min, respectively, and were significantly longer for concomitant procedures (p < 0.001). There were no aortic dissections and no deep venous thromboses. Operative mortality (none neurologic) and major stroke occurred in 7 (1.4%) and 4 (0.8%) patients, respectively. These rates compared favorably with the published literature on isolated primary mitral valve surgery (MVS) through sternotomy or minithoracotomy (mortality rates 0.2% to 11.6%, stroke rates 0.6% to 4.4%).
  
  
  CONCLUSIONS
  Once procedural proficiency is acquired, endoaortic balloon clamping in MIMVS is a safe and effective technique. Despite the fact that this patient cohort also includes combined and redo procedures, the observed mortality and stroke rate compared favorably with the existing literature on primary isolated mitral valve surgery irrespective of the approach.
authors.affiliation: Department of Cardiovascular & Thoracic Surgery, OLV, Aalst, Belgium. Electronic address: filip.casselman@olvz-aalst.be.
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.affiliation: Department of Cardiac Surgery, Hospital de Cruces, Bilbao, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Aramendi
authors.affiliation: Department of Cardiothoracic Surgery, Amphia Breda Hospital, Breda, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bentala
authors.affiliation: Biostatistics, Edwards Lifesciences, Nyon, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Candolfi
authors.affiliation: Department of Cardiac Surgery, Schûchtermann Klinik, Bad Rothenfelde, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Coppoolse
authors.affiliation: Department of Cardiovascular Surgery, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Gersak
authors.affiliation: Department of Cardiac Surgery, Policlinico Umberto I, Rome, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Greco
authors.affiliation: Department of Cardiac Surgery, Gasthuisberg, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.affiliation: Department of Cardiac Surgery, Northern General Hospital, Sheffield, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Hunter
authors.affiliation: Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krakor
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliera San Giovanni Battista, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Department of Cardiovascular & Thoracic Surgery, OLV, Aalst, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
authors.affiliation: Department of Cardiovascular & Thoracic Surgery, OLV, Aalst, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Van Vaerenbergh
authors.affiliation: Department of Cardiac Surgery, Victoria Hospital, Blackpool, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zacharias
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D013908:Thoracotomy