OC84 TRANSTHORACIC CLAMP AND ENDOAORTIC OCCLUSION FOR MINIMALLY INVASIVE CARDIAC SURGERY

Background and Aim: Two techniques of aortic occlusion have been used in small thoracotomy cardiac surgery: transthoracic clamp (TTC) and endoaortic balloon occlusion (EAO). Both techniques present peculiar advantages and limitations whose current evidences are based on observational studies. We report our experience comparing early outcomes of these two techniques. Methods: 235 consecutive patients underwent minimally invasive cardiac surgery through right mini-thoracotomy from January 2013 to March 2018.One-hundred forty-two patients were operated on with TTC, in 93 cases EAO was used. Mean age was 60.1 ± 13.6, patients with TTC were significantly older (62.4 ± 12.4 TTC vs. 56.1 ± 14.5 EAO, p = 0.0002); reoperations were carried out mostly with EAO (2% TTC vs. 12% EAO, p = 0.005). No differences were detected between the two techniques in terms of types of operation, CPB and cardioplegic arrest times. Results: Similar values of postoperative Troponin I and CK-Mb were recorded. New neurologic deficit occurred in 6 patients, 2 temporary deficit in the TTC patients and 4 strokes in the EAO group (p = 0.048). There was no case of aortic dissection, no patient suffered peripheral ischaemia. Overall hospital mortality was 2.1%, 1.4% in TTC and 3.2% in EAO (p = 0.62); hospital mortality, excluding redo-operations was 1.4%, 1.4% in TTC and 1.2% in EAO (p = 0.98). Conclusions: Both TTC and EAO provided to be safe.A higher rate of cerebral stroke was observed in the EAO group. However, the use of endo-aortic balloon inflation system showed technical advantages in avoiding tissue dissection and aortic manipulations. It remains our choice in redo operations.