Clinical Impact of the Endo-aortic Clamp for Redo Mitral Valve Surgery

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-04-17 DOI:10.1007/s12265-024-10509-7

Cristina Barbero, Andrea Costamagna, Peter Verbrugghe, Joseph Zacharias, Frank Van Praet, Thierry Bove, Alfonso Agnino, Jörg Kempfert, Mauro Rinaldi

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Abstract

Aim of this study was to compare redo MV surgery patients undergoing right mini-thoracotomy and EAC with redo MV patients undergoing surgery through other approaches. Redo MV patients from 7 European centers were analyzed. Primary endpoint was 30-day mortality; secondary endpoints were stroke, re-exploration, low cardiac output syndrome (LCOS), respiratory failure, and intensive care unit (ICU) and in-hospital length-of-stay. Forty-nine patients underwent right mini-thoracotomy and EAC (22.7%), and 167 (77.3%) underwent surgery through other approaches (112 sternotomy, 40 unclamped mini-thoracotomies, and 15 mini-thoracotomies with trans-thoracic clamp). Thirty-day mortality, stroke, re-exploration for bleeding, and weaning failure were comparable. The EAC group showed significant lower rate of LCOS (p = 0.03) and shorter ICU (p = 0.04) and in-hospital length of stay (p = 0.002). The EAC allows the surgeon to reach the aorta, to clamp it, and to deliver the cardioplegia with a “no-touch” technique, with significant improvement in outcomes.

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重做二尖瓣手术中主动脉内夹钳的临床影响

这项研究的目的是比较接受右小胸廓切开术和EAC手术的中风再手术患者与接受其他方法手术的中风再手术患者。对来自欧洲 7 个中心的重做中风患者进行了分析。主要终点是30天死亡率；次要终点是中风、再次手术、低心排量综合征（LCOS）、呼吸衰竭、重症监护室（ICU）和住院时间。49名患者（22.7%）接受了右侧小胸腔切开术和EAC手术，167名患者（77.3%）通过其他方法接受了手术（112例胸骨切开术、40例未钳夹的小胸腔切开术和15例经胸腔钳夹的小胸腔切开术）。30天死亡率、中风、因出血再次手术和断奶失败率相当。EAC 组的 LCOS 发生率明显降低（p = 0.03），ICU（p = 0.04）和住院时间（p = 0.002）明显缩短。EAC 使外科医生能够触及主动脉、钳夹主动脉并以 "无接触 "技术提供心脏麻痹，显著改善了预后。

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