Complications and pitfalls in minimally invasive atrioventricular valve surgery utilizing endo-aortic balloon occlusion technology

Summary This systematic review and meta-analysis aims to determine outcomes following aortic occlusion with the transthoracic clamp (TTC) versus endoaortic balloon occlusion (EABO) in patients undergoing minimally invasive mitral valve surgery. A subgroup analysis compares TTC to EABO with femoral cannulation separately from EABO with aortic cannulation. We searched Medline and Embase up to December 2018. Two people independently and in duplicate screened title and abstracts, full-text reports, extracted data and assessed the risk of bias using the Cochrane risk-of-bias tool for non-randomized studies. We identified 1564 reports from which 11 observational studies with 4181 participants met the inclusion criteria. We found no evidence of difference in the risk of postoperative death or cerebrovascular accident (CVA) between the 2 techniques. Evidence for a reduction in aortic dissection with TTC was found: 4 of 1590 for the TTC group vs 19 of 2492 for the EABO group [risk ratio 0.33, 95% confidence interval (CI) 0.12–0.93; P = 0.04]. There was no difference in aortic cross-clamp (AoX) time between TTC and EABO [mean difference (MD) −5.17 min, 95% CI −12.40 to 2.06; P = 0.16]. TTC was associated with a shorter AoX time compared to EABO with femoral cannulation (MD −9.26 min, 95% CI −17.00 to −1.52; P = 0.02). EABO with aortic cannulation was associated with a shorter AoX time compared to TTC (MD 7.77 min, 95% CI 3.29–12.26; P < 0.001). There was no difference in cardiopulmonary bypass (CPB) time between TTC and EABO with aortic cannulation (MD −4.98 min, 95% CI −14.41 to 4.45; P = 0.3). TTC was associated with a shorter CPB time compared to EABO with femoral cannulation (MD −10.08 min, 95% CI −19.93 to −0.22; P = 0.05). Despite a higher risk of aortic dissection with EABO, the rates of survival and cerebrovascular accident across the 2 techniques are similar in minimally invasive mitral valve surgery.

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Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy027 ◽

2018 ◽

Vol 54 (2) ◽

pp. 288-293 ◽

Cited By ~ 1

Author(s):

Johan van der Merwe ◽

Frank Van Praet ◽

Bernard Stockman ◽

Ivan Degrieck ◽

Yvette Vermeulen ◽

...

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Atrioventricular Valve ◽

Aortic Valve Surgery ◽

Port Access

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Minimally invasive mitral valve repair using intra-aortic balloon occlusion and 3D HD camera system

ASVIDE ◽

10.21037/asvide.2016.455 ◽

2016 ◽

Vol 3 ◽

pp. 455-455

Author(s):

Markus Czesla ◽

Christian Mogilansky ◽

Robert Balan ◽

Sven Kattner ◽

Gerrit van Ingen ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Balloon Occlusion ◽

Valve Repair ◽

Camera System ◽

Aortic Balloon Occlusion

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The impact of cardiopulmonary bypass management on outcome: a propensity matched comparison between minimally invasive and conventional valve surgery

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa052 ◽

2020 ◽

Vol 31 (1) ◽

pp. 48-55 ◽

Cited By ~ 1

Author(s):

Korneel Vandewiele ◽

Filip De Somer ◽

Michael Vandenheuvel ◽

Tine Philipsen ◽

Thierry Bové

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Minimally Invasive ◽

Haemoglobin Concentration ◽

Kidney Injury ◽

Valve Surgery ◽

Flow Index ◽

Atrioventricular Valve ◽

Pump Flow ◽

Matched Comparison

Abstract OBJECTIVES Research concerning cardiopulmonary bypass (CPB) management during minimally invasive cardiac surgery (MICS) is scarce. We investigated the effect of CPB parameters such as pump flow, haemoglobin concentration and oxygen delivery on clinical outcome and renal function in a propensity matched comparison between MICS and median sternotomy (MS) for atrioventricular valve surgery. METHODS A total of 356 patients undergoing MICS or MS for atrioventricular valve surgery between 2006 and 2017 were analysed retrospectively. Propensity score analysis matched 90 patients in the MS group with 143 in the MICS group. Logistic regression analysis was performed to investigate independent predictors of cardiac surgery-associated acute kidney injury in patients having MICS. RESULTS In MICS, CPB (142.9 ± 39.4 vs 101.0 ± 38.3 min; P < 0.001) and aortic cross-clamp duration (89.9 ± 30.6 vs 63.5 ± 23.0 min; P < 0.001) were significantly prolonged although no differences in clinical outcomes were detected. The pump flow index was lower [2.2 ± 0.2 vs 2.4 ± 0.1 l⋅(min⋅m2)−1; P < 0.001] whereas intraoperative haemoglobin levels were higher (9.25 ± 1.1 vs 8.8 ± 1.2; P = 0.004) and the nadir oxygen delivery was lower [260.8 ± 43.5 vs 273.7 ± 43.7 ml⋅(min⋅m2)−1; P = 0.029] during MICS. Regression analysis revealed that the nadir haemoglobin concentration during CPB was the sole independent predictor of cardiac surgery-associated acute kidney injury (odds ratio 0.67, 95% confidence interval 0.46–0.96; P = 0.029) in MICS but not in MS. CONCLUSIONS Specific cannulation-related issues lead to CPB management during MICS being confronted with flow restrictions because an average pump flow index ≤2.2 l/min/m2 is achieved in 40% of patients who have MICS compared to those who have a conventional MS. This study showed that increasing the haemoglobin level might be helpful to reduce the incidence of cardiac surgery-associated acute kidney injury after minimally invasive mitral valve surgery.

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