Abstract
BackgroundMinimally invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass. Conventional external aortic clamping (exoclamping) is not always feasible, so endoaortic clamping (endoclamping) has evolved as a viable alternative. The aim of this study is to compare endoclamping (Intraclude™, Edwards Lifesciences) with exoclamping (Chitwood) during minimally invasive mitral valve procedures.MethodsThis single-centre study included 822 consecutive patients undergoing minimally invasive mitral valve procedures. The endoclamp was used in 64 patients and the exoclamp in 758. Propensity-score (PS) matching was performed resulting in 63 patients per group. Outcome measures included procedural variables, length of intensive care unit (ICU) and hospital stay, major adverse cardiac and cerebrovascular events (MACCE) and repeat surgery.ResultsThe mean age was similar in the two group (62.2 [endoclamp] vs. 63.5 [exoclamp] years; p = 0.554), as were the cardiopulmonary bypass (145 vs. 156 min; p = 0.707) and the procedure time (203 vs. 211 min; p = 0.648). The X-clamp time was significantly shorter in the endoclamp group (88 vs. 99 min; p = 0.042). Length of ICU stay (25.0 vs. 23.0 h) and length of hospital stay (10.0 vs. 9.0 days) were slightly longer in the endoclamp group, but without statistical significance. There were nominal but no statistically significant differences between the groups in the rates of stroke, vascular complications, myocardial infarction or repeat mitral valve surgery. The conversion rate to open sternotomy approach was 2.4% without difference between groups. The estimated 7-year survival rate was similar for both groups (89.9% [endoclamp]; 84.0% [exoclamp]) with a hazard ratio of 1.291 (95% CI 0.453–3.680).ConclusionsEndoaortic clamping is an appropriate and reasonably safe alternative to the conventional Chitwood exoclamp for patients in which the exoclamp cannot be used because the ascending aorta cannot be safely mobilised.
Highlights
Invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass
Minimally invasive mitral valve surgery (MIMVS) is becoming the standard-of-care in suitable cases in many centres. It is commonly associated with the need for cardiopulmonary bypass, but conventional external aortic clamping (‘exoclamping’) is not always feasible or desirable
Among 822 consecutive MIMVS procedures performed at our centre between 2009 and 2015, the endoclamp was used in 64 patients and the exoclamp in 758 patients (Fig. 1)
Summary
Invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass. Conventional external aortic clamping (exoclamping) is not always feasible, so endoaortic clamping (endoclamping) has evolved as a viable alternative. Invasive mitral valve surgery (MIMVS) is becoming the standard-of-care in suitable cases in many centres It is commonly associated with the need for cardiopulmonary bypass, but conventional external aortic clamping (‘exoclamping’) is not always feasible or desirable. In this setting, endoaortic clamping (‘endoclamping’) has evolved into a viable alternative for providing aortic cross-clamping, antegrade cardioplegia and aortic root venting. Costs for the endoclamp are higher than for the standard exoclamp
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