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Endoaortic Balloon Occlusion In Patients Undergoing Totally Endoscopic Mitral Valve Surgery With Ascending Aortic Dilation
Sarah L. Breves1, Inki Hong1, G William Moser2, James McCarthy2, Mohammed Kashem2, Thomas M. Kelley, Jr3, T Sloane Guy, MD2.
1Temple University School of Medicine, Philadelphia, PA, USA, 2Temple University Hospital, Philadelphia, PA, USA, 3Dwight D. Eisenhower Army Medical Center, Augusta, GA, USA.
OBJECTIVE: Aortic occlusion with an endoballoon is a well established technique in conducting robotic mitral valve surgery. Use of the endoballoon has relative contraindications, per the Instructions for Use (IFU), including ascending aortic aneurysm. We sought to examine the safety of using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 37mm.
METHODS: A retrospective review of a single site database was conducted to identify patients undergoing totally-endoscopic mitral valve surgery utilizing an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 37mm. All surgeries were conducted by a single surgeon. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, occlude the ascending aorta and to deliver cardioplegia. Computed tomography was done pre-operatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Chart review was done to identify any intra-operative as well as post-operative aortic complications.
RESULTS: From October 2011 through March 2014, 106 patients (5 male, 2 female) underwent totally endoscopic mitral valve surgery utilizing an endoballoon at our institution. Seven patients (6.6%) had ascending aortic diameters greater than 37mm (range 37.1mm-42.1mm, average 39.4mm). There were no instances of aortic dissection, balloon puncture, balloon rupture, balloon migration, damage to aortic intima, device movement leading to loss of occlusion, failure to deliver cardioplegia, or inability to complete planned surgery due to occlusion failure in any of the 7 patients.
CONCLUSIONS: 7 out of 7 patients with ascending aortas greater than 37 mm successfully completed totally endoscopic mitral valve surgery with no direct complications.
| Gender | AGE | Height(in) | BMI | Cross Clamp Time (min) | Ascending Aortic Size (mm) |
| M | 68 | 71 | 30.86 | 73 | 37.1 |
| M | 66 | 73 | 29.8 | 117 | 38.1 |
| F | 60 | 64 | 21.5 | 96 | 38.1 |
| M | 37 | 74 | 31.5 | 107 | 39.4 |
| F | 73 | 63 | 34.5 | 68 | 39.4 |
| M | 59 | 69 | 27.3 | 66 | 41.5 |
| M | 65 | 74 | 33.4 | 89 | 42.1 |
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