Long-Term Follow-Up of Minimally Invasive Cardiac Surgery Using an Endoaortic Occlusion System
DOI:
https://doi.org/10.1532/HSF98.2014316Abstract
Objectives: We reviewed the initial patient series (n=116) of our institution performing minimally invasive coronary artery bypass grafting (CABG) (n=79), mitral valve surgery (n=1), or atrial septal closure (ASD) procedures (n=26) using an endoaortic occlusion system. With this technique relevant intra-aortic pressures are exerted on the aortic wall during the clamping time. This might lead to late aortic degeneration and aneurysm formation. Our study sought to evaluate postoperative aortic complications and the quality of life (modified SF-12).
Methods: One hundred sixteen patients (56% male; 54 years ± 14.5; range 19 years to 77 years) underwent a cardiac procedure using an endoaortic clamp. The endoaortic balloon clamp catheter was used to occlude the ascending aorta at pressures >300 mmHg. Patients were rescheduled for echocardiographic examination after a mean follow-up period of 8.8 years.
Results: The analysis performed among 78 patients showed no incidence of any structural damage to the ascending aorta at the intraoperative position of the endoaortic balloon. The physical and mental summary scores are equal to those of comparable patient groups.
Conclusions: The endoaortic occlusion system causes no damage to the aortic wall. If the system causes any problems, they occur immediately during surgery. Patients treated with this minimally invasive technique exhibited the same quality of life as those undergoing conventional surgery.
References
Aybek T, Dogan S, Wimmer-Greinecker G, et al. 2000. The micro-mitral operation comparing the Port-Access technique and the transthoracic clamp technique. J Card Surg 15(1):76-81.nBonatti J, Lee JD, Bonaros N, et al. 2012. Robotic totally endoscopic multivessel coronary artery bypass grafting: procedure development, challenges, results. Innovations (Phila) 7(1):3-8.nChan EY, Lumbao DM, Iribarne A, et al. 2012. Evolution of cannulation techniques for minimally invasive cardiac surgery: a 10-year journey. Innovations (Phila) 7(1):9-14.nDogan S, Graubitz K, Aybek T, et al. 2002. How safe is the port access technique in minimally invasive coronary artery bypass grafting? Ann Thorac Surg 74(5):1537-43; discussion 1543.nFailde I, Medina P, Ramirez C, et al. 2010. Construct and criterion validity of the SF-12 health questionnaire in patients with acute myocardial infarction and unstable angina. J Eval Clin Pract 16(3):569-73.nFann JI, Pompili MF, Stevens JH, et al. 1997. Port-access cardiac operations with cardioplegic arrest. Ann Thorac Surg 63(6 Suppl):S35-9.nGrossi EA, Loulmet DF, Schwartz CF, et al. 2012. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg 1433.nHesselvik JF, Ortega RA, Treanor P, et al. 1999. Intraoperative rupture of the endoaortic clamp balloon in a patient undergoing port-access mitral valve repair. J Cardiothorac Vasc Anesth 13(4):462-5.nIus F, Mazzaro E, Tursi V, et al. 2009. Clinical results of minimally invasive mitral valve surgery: endoaortic clamp versus external aortic clamp techniques. Innovations (Phila) 4(6):311-8.nKrapf C, Wohlrab P, Häußinger S, et al. 2013. Remote access perfusion for minimally invasive cardiac surgery: to clamp or to inflate? Eur J Cardiothorac Surg 22.nLoforte A, Luzi G, Montalto A, et al. 2010. Video-assisted minimally invasive mitral valve surgery: external aortic clamp versus endoclamp techniques. Innovations (Phila) 5(6):413-8.nSchachner T, Bonaros N, Feuchtner G, et al. 2005. How to handle remote access perfusion for endoscopic cardiac surgery. Heart Surg Forum 8(4):E232-5.nSchachner T, Bonaros N, Laufer G, et al. 2004. The ESTECH remote access perfusion cannula in minimally invasive cardiac surgery. Heart Surg Forum 7(6):E632-5.nSen B, Niemann B, Roth P, et al. 2012. Short- and long-term outcomes in octogenarians after coronary artery bypass surgery. Eur JCardiothorac Surg 42(5) 2.nViganó M, Minzioni G, Spreafico, et al. 2000. Port Access Cardiac Surgery. Surg Technol Int IX:231-236.nVistarini N, Aiello M, Mattiucci G, et al. 2010. Port-access minimally invasive surgery for atrial septal defects: a 10-year single-center experience in 166 patients. J Thorac Cardiovasc Surg 139(1):139-45.nWimmer-Greinecker G, Matheis G, Dogan S, et al. 1999. Complications of port-access cardiac surgery. J Card Surg 14(4):240-5.nYozu R, Shin H, Maehara T. 2002. Minimally invasive cardiac surgery by the port-access method. Artif Organs 26(5):430-7.nZingone B, Gatti G, Rauber, et al. 2006. Surgical management of the atherosclerotic ascending aorta: is endoaortic balloon occlusion safe? Ann Thorac Surg 82(5):1709-14.n
