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Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection

Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minima...

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Autores principales: Barbero, Cristina, Rinaldi, Mauro, Pocar, Marco, Cura Stura, Erik, Calia, Claudia, Sebastiano, Viviana, Marchetto, Giovanni, Filippini, Claudia, Boffini, Massimo, Ricci, Davide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458726/
https://www.ncbi.nlm.nih.gov/pubmed/34568461
http://dx.doi.org/10.3389/fcvm.2021.719687
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author Barbero, Cristina
Rinaldi, Mauro
Pocar, Marco
Cura Stura, Erik
Calia, Claudia
Sebastiano, Viviana
Marchetto, Giovanni
Filippini, Claudia
Boffini, Massimo
Ricci, Davide
author_facet Barbero, Cristina
Rinaldi, Mauro
Pocar, Marco
Cura Stura, Erik
Calia, Claudia
Sebastiano, Viviana
Marchetto, Giovanni
Filippini, Claudia
Boffini, Massimo
Ricci, Davide
author_sort Barbero, Cristina
collection PubMed
description Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. Methods: A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Results: Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Conclusion: Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery.
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spelling pubmed-84587262021-09-24 Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection Barbero, Cristina Rinaldi, Mauro Pocar, Marco Cura Stura, Erik Calia, Claudia Sebastiano, Viviana Marchetto, Giovanni Filippini, Claudia Boffini, Massimo Ricci, Davide Front Cardiovasc Med Cardiovascular Medicine Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. Methods: A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Results: Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Conclusion: Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery. Frontiers Media S.A. 2021-09-09 /pmc/articles/PMC8458726/ /pubmed/34568461 http://dx.doi.org/10.3389/fcvm.2021.719687 Text en Copyright © 2021 Barbero, Rinaldi, Pocar, Cura Stura, Calia, Sebastiano, Marchetto, Filippini, Boffini and Ricci. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Barbero, Cristina
Rinaldi, Mauro
Pocar, Marco
Cura Stura, Erik
Calia, Claudia
Sebastiano, Viviana
Marchetto, Giovanni
Filippini, Claudia
Boffini, Massimo
Ricci, Davide
Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title_full Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title_fullStr Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title_full_unstemmed Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title_short Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection
title_sort endo-aortic vs. trans-thoracic clamping in right mini-thoracotomy mitral valve surgery: outcome on myocardial protection
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458726/
https://www.ncbi.nlm.nih.gov/pubmed/34568461
http://dx.doi.org/10.3389/fcvm.2021.719687
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