Defne G. Ergi, MD: No financial relationships to disclose
Purpose: Both transthoracic aortic cross-clamping (TACC) and endoaortic balloon occlusion (EABO) have been shown to have comparable safety profiles for aortic occlusion(1). Since most minimally invasive surgeons use only one technique, we sought to compare the surgical outcomes when a homogeneous group of surgeons their occlusion technique from TACC to EABO. Methods: Our robotic surgery group changed their aortic occlusion technique from TACC to EABO in November 2022. This allowed us to conduct a prospective treatment comparison study comparing EABO to TACC technique in the same consistent group of surgeons. Propensity score matching (PSM) was used to match cases (EABO) 1:3 to controls (TACC) based on age, gender, BMI, Maze, and concomitant tricuspid valve repair. Complexity of the valvuloplasty was defined as simple or complex, where simple was defined as limited leaflet dysfunction requiring only annuloplasty with or without posterior leaflet repair, and complex was defined as all others(2). Results: There were 411 patients who underwent robotic-assisted mitral valvuloplasty from 2020 to 2023. Using PSM all 56 EABO patient were matched to 168 TACC patients (total of 411). Median age was 65 years (Interquartile Range [IQR] 55.6-70.0) and the majority were male (119, 53%). All valves were repaired successfully. The rate of complex mitral valve repair was similar between the two groups (TACC: n=60,35.7% vs EABO: n=22,39.3%, p=0.631). Median cardiopulmonary bypass (CPB) time was shorter in the EABO group (84.0 vs 94.5min, p=0.006). But median cross-clamp time (64.0 vs 64.0 min, p=0.483) and total surgery time (5.9 vs 6.1 hours, p=0495) were not different between groups (Figure 1). Length of stay, 30-day mortality, and other outcomes were similar between the two groups (Table 1). There were 5 surgeons involved in all the operations. They performed the operations in different combinations as console and bedside positions. CPB, cross-clamp and surgery durations were not significantly affected by the different combinations of console and bedside surgeons. Conclusion: Conversion from a transthoracic aortic occlusion technique for robotic-assisted mitral repair to an endoaortic balloon occlusion technique resulted in similar perioperative clinical outcomes including a 100% mitral repair rate while slightly reducing the CPB time.
Identify the source of the funding for this research project: none
