We compare outcomes of endo-aortic balloon occlusion (EABO) versus external aortic
clamping (EAC) in patients undergoing minimally invasive mitral valve surgery (MIMVS)
in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Adults undergoing
mitral valve surgery (July 2017 – December 2018) were identified within the STS database
(N=60,607). 7,978 patients underwent a minimally invasive approach (including robotically
assisted). 1,163 EABO patients were 1:1 propensity-matched to EAC patients using exact
matching on age, sex, and type of mitral procedure, and propensity-score average matching
for 16 other risk indicators. Early outcomes were compared. Categorical variables
were compared using logistic regression; hospital and intensive care unit (ICU) length
of stay (LOS) were compared using negative binomial regression. In the matched cohort,
mean age was 62 years; 35.9% were female, and 86% underwent mitral valve repair. Cardiopulmonary
bypass time was shorter for EABO versus EAC group (125.0±53.0 vs 134.0 ±67.0 minutes,
P=0.0009). There was one aortic dissection in the EAC group and none in the EABO group,
(p-value>0.31), and no statistically significant differences in cross-clamp time,
major intraoperative bleeding, perioperative mortality, stroke, new onset of atrial
fibrillation, postoperative AKI, success of repair. Median hospital LOS was shorter
for EABO versus EAC procedures (4 versus 5 days, P<0.0001). In this large, retrospective,
STS database propensity matched analysis of patients undergoing MIMVS, we observed
similar safety outcomes for EABO and EAC, including no aortic dissections in the EABO
group. The EABO group showed slightly shorter CPB times and hospital LOS.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AKI (acute kidney injury), CPB (cardiopulmonary bypass), EABO (endo-aortic balloon occlusion), EAC (external aortic clamping), GLM (generalized linear modeling), ICU (intensive care unit), IRR (incident rate ratio), LOS (length of stay), MI (myocardial infarction), MIMVS (minimally invasive mitral valve surgery), MR (mitral regurgitation), STS (Society of Thoracic Surgeons), TIA (transient ischemic attack)To read this article in full you will need to make a payment
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Article info
Publication history
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Statement: Funding for this research was provided by Edwards Lifesciences.
Conflict of Interest:
H Balkhy is a proctor for Edwards Lifesciences and Intuitive
E Grossi receives IP royalties from Edwards Lifesciences for valve technologies
B Kiaii is a consultant for Medtronic, Abbott and Johnson and Johnson
D Murphy is a proctor for Intuitive
S Guy is a consultant for Johnson and Johnson, Medtronic and Intuitive
A Geirsson is a consultant for Edwards Lifesciences
IRB/Informed consent information: As this was a non-interventional, retrospective, observational study using de-identified data for patients who met eligibility criteria, informed consent was not required from patients under an Institutional Review Board exemption status. All aspects of this study were conducted in compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 regulations and the HIPAA Omnibus Rule of 2013.
Read at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.
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