Minimally Invasive Mitral Valve Surgery: Which Cross-clamp Should I Apply?

Objective: To compare the usefulness and the outcomes of two different aortic cross-clamp strategies during minimally invasive mitral valve surgery (mini-MVS). Methods: From October 2013 to date, 166 patients underwent mini-MVS. The IntraClude® intra-aortic occlusion system (Irvine, California) was used in 65 (39.1%) patients, while a SCANLAN® Chitwood-DeBakey clamp was used in 97 patients (58.4%). Results: No differences were observed in the operative times between the IntraClude® (Cross Clamp time (XCT): 87.06±21.9 minutes, Cardiopulmonary By-pass time (CPB): 116.9±24.1 minutes) and the Chitwood-DeBakey clamp (XCT: 84.07±18.73, CPB: 118.8±27 minutes), p>0.05. Post-CPB incidence of ventricular fibrillation, as possible marker of ischaemic events or air into the coronary system, seems to be greater in the IntraClude® group, when compared with the remnant cases. (2 (3.07%) vs 1 (1.03%) cases, respectively). The incidence of conversion to full sternotomy was greater for the IntraClude® group (5 (7.4%), than the Chitwood-DeBakey clamp (1 (1.5%). The redo mitral procedures were 7 in total (4.2%): in 3 of those cases, the IntraClude® device was used, while in four cases (2.4%), it was decided to use CPB with beating heart and/or ventricular fibrillation. Conclusions: Chitwood-DeBakey cross-clamp provides a reliable technique for minimally invasive mitral surgery, when the aorta is safe to manipulate, with good operative times and incidence of post-operative complications. The IntraClude® intra-aortic occlusion system is generally preferred in redo patients and with ascending aorta disease.