Ascending Aortic Endoballoon Occlusion Feasible Despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery.
OBJECTIVE
Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm.


METHODS
A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia.


RESULTS
From October 2011 through June 2015, 196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1-46.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure.


CONCLUSIONS
Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.
From the *Temple University School of Medicine, Philadelphia, PA USA; †Division of Cardiovascular Surgery, Temple University School of Medicine, Philadelphia, PA USA; ‡Department of Surgery, Dwight D. Eisenhower Army Medical Center, Augusta, GA USA; and §Department of Cardiothoracic Surgery, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY USA.
Sarah L
SL
Breves
Inki
I
Hong
James
J
McCarthy
Mohammed
M
Kashem
G William
GW
Moser
Thomas M
TM
Kelley
Erin E
EE
Mills
Grayson H
GH
Wheatley
T Sloane
TS
Guy
D000368:Aged; D001011:Aorta / Q000002:abnormalities*; D001018:Aortic Diseases / Q000628:therapy*; D021721:Balloon Occlusion / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D004108:Dilatation, Pathologic; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome