Endo-Aortic Balloon Occlusion versus Transthoracic Clamping in Minimally Invasive Mitral Valve Surgery

Objectives The present study compared the clinical outcome between endo-aortic balloon occlusion (EABO) and transthoracic clamping (TTC) in patients undergoing minimally invasive mitral valve surgery (MIMVS). Methods All patients from the Mini-Mitral International Registry undergoing MIMVS were primarily considered for study inclusion. One-to-one nearest neighbour propensity score matching considering clinically relevant baseline covariates. The matched cohort was investigated regarding the clinical outcome between EABO and TTC according to the end-point definitions of the Mitral Valve Academic Research Consortium. Results From 2015 to 2021, a total of 6884 patients were primarily included in the study. Propensity score matching resulted in a population of 733 matched pairs. Patients treated with EABO showed significantly lower rates of conversion to sternotomy (13 [1.8%] vs 34 [4. 6%]; P =. 001), longer cardiopulmonary bypass time (124 min [105-147] vs 120 min [90-148]; P =. 001), and a longer intubation time (11.8 h [7.9-22.2] vs 10.8 h [6.4-20.0]; P <. 001). No statistically significant differences were observed regarding postoperative mortality, stroke, bleeding requiring revision, vascular complications, intensive care unit stay, or hospital length of stay. Conclusions In patients undergoing MIMVS, EABO and TTC are excellent options for aortic clamping. EABO showed benefits over TTC with lower rates of conversion to full sternotomy.