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Updated: Apr 9, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery
Mohamed Bentala1, Samuel Heuts2, Rein Vos3
1Department of Cardiothoracic Surgery, Amphia Hospital, Breda, Netherlands mbentala@amphia.nl.
Objectives:
The aim of this study was to assess the differences in perioperative outcomes and complications between the endo-aortic balloon (EAB) and the external aortic clamp (EAC) during primary elective minimally invasive mitral valve surgery (MIMVS) in a single referral centre by one surgeon. Primary outcomes were cardiopulmonary bypass time (CPB), cross-clamp time (CX) and occurrence of postoperative cerebrovascular accidents (CVAs). Secondary outcomes were other perioperative parameters and complications.
Methods:
We retrospectively analysed 340 consecutive patients who underwent MIMVS for mitral regurgitation (MR), mitral stenosis or combined regurgitation/stenosis between November 2010 and March 2014 in a single referral centre. In total, 221 patients who underwent an isolated mitral valve repair or isolated mitral valve replacement or repair/replacement combined with an atrial fibrillation (AF)-ablation procedure were included. Patients who had previous cardiac surgery or concomitant tricuspid valve surgery, myxoma or atrial septal defect closure surgery were excluded.
Results:
A total of 57 patients (Group A) underwent MIMVS using the EAC and 164 patients (Group B) were operated using an EAB. Preoperative variables showed a significant difference in poor left ventricular function (LVF, P = 0.18) and moderate LVF (P = 0.019). No significant differences were found in CPB-time, cross-clamp time or postoperative CVA. Furthermore, no significant differences were found in complications, 30-day mortality or postoperative echocardiographical MR gradation. Hospital stay, however, was prolonged in Group A (P = 0.001) and maximum troponin T levels were significantly lower in Group B (P = 0.014). In Group B however, 10 procedures were converted (6%) from EAB to EAC.
Conclusions:
There is no difference in use between the EAB and the EAC in terms of CPB-time and cross-clamp time, complications or MR gradation at discharge. Use of the EAC showed significantly higher postoperative levels of troponin T, implying more myocardial damage, compared with the EAB. In 6% of the cases however, patients were converted from the EAB to the EAC.
Insights
The endo-aortic balloon (EAB) and external aortic clamp (EAC) show similar outcomes for minimally invasive mitral valve surgery (MIMVS). The EAC group had higher troponin T levels, suggesting more myocardial damage, and longer hospital stays.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Valvular Heart Disease
Background:
- Minimally invasive mitral valve surgery (MIMVS) offers advantages but requires effective aortic occlusion.
- Both endo-aortic balloon (EAB) and external aortic clamp (EAC) are used for aortic occlusion during MIMVS.
- Comparative data on perioperative outcomes between EAB and EAC in MIMVS are limited.
Purpose of the Study:
- To compare perioperative outcomes and complications between EAB and EAC during primary elective MIMVS.
- To assess differences in cardiopulmonary bypass time, cross-clamp time, and cerebrovascular accidents.
- To evaluate other perioperative parameters and complications associated with each method.
Main Methods:
- Retrospective analysis of 340 patients undergoing MIMVS for mitral valve disease.
- Inclusion of 221 patients who had isolated mitral valve repair/replacement or with atrial fibrillation ablation.
- Exclusion of patients with prior cardiac surgery or concomitant procedures.
Main Results:
- No significant differences in cardiopulmonary bypass time, cross-clamp time, or postoperative cerebrovascular accidents between EAB and EAC groups.
- External aortic clamp (EAC) group showed significantly higher postoperative troponin T levels and prolonged hospital stay.
- Ten procedures (6%) in the EAB group required conversion to EAC.
Conclusions:
- Both EAB and EAC are comparable in terms of cardiopulmonary bypass time, cross-clamp time, and overall complications in MIMVS.
- The EAC may be associated with increased myocardial damage, indicated by higher troponin T levels.
- Conversion from EAB to EAC occurred in 6% of cases, highlighting potential technical challenges.
