Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection

Cristina Barbero; Mauro Rinaldi; Marco Pocar; Erik Cura Stura; Claudia Calia; Viviana Sebastiano; Giovanni Marchetto; Claudia Filippini; Massimo Boffini; Davide Ricci

doi:10.3389/fcvm.2021.719687

Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection

Front Cardiovasc Med. 2021 Sep 9:8:719687. doi: 10.3389/fcvm.2021.719687. eCollection 2021.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.
² Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
³ Department of Anesthesia and Critical Care, University of Turin, Turin, Italy.
⁴ Cardiac Surgery Unit, Scientific Institute for Research, Hospitalization and Healthcare Policlinic Hospital San Martino, Genova, Italy.
⁵ Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy.

Abstract

Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. Methods: A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Results: Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Conclusion: Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery.

Keywords: aortic clamping; cardioplegia; cardiopulmary bypass; minimally invasive cardiac surgery; mitral valve; mitral valve repair; myocardial protection.