Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany.
Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
J Cardiothorac Surg. 2020 Oct 14;15(1):313. doi: 10.1186/s13019-020-01363-0.
Minimally invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass. Conventional external aortic clamping (exoclamping) is not always feasible, so endoaortic clamping (endoclamping) has evolved as a viable alternative. The aim of this study is to compare endoclamping (Intraclude™, Edwards Lifesciences) with exoclamping (Chitwood) during minimally invasive mitral valve procedures.
This single-centre study included 822 consecutive patients undergoing minimally invasive mitral valve procedures. The endoclamp was used in 64 patients and the exoclamp in 758. Propensity-score (PS) matching was performed resulting in 63 patients per group. Outcome measures included procedural variables, length of intensive care unit (ICU) and hospital stay, major adverse cardiac and cerebrovascular events (MACCE) and repeat surgery.
The mean age was similar in the two group (62.2 [endoclamp] vs. 63.5 [exoclamp] years; p = 0.554), as were the cardiopulmonary bypass (145 vs. 156 min; p = 0.707) and the procedure time (203 vs. 211 min; p = 0.648). The X-clamp time was significantly shorter in the endoclamp group (88 vs. 99 min; p = 0.042). Length of ICU stay (25.0 vs. 23.0 h) and length of hospital stay (10.0 vs. 9.0 days) were slightly longer in the endoclamp group, but without statistical significance. There were nominal but no statistically significant differences between the groups in the rates of stroke, vascular complications, myocardial infarction or repeat mitral valve surgery. The conversion rate to open sternotomy approach was 2.4% without difference between groups. The estimated 7-year survival rate was similar for both groups (89.9% [endoclamp]; 84.0% [exoclamp]) with a hazard ratio of 1.291 (95% CI 0.453-3.680).
Endoaortic clamping is an appropriate and reasonably safe alternative to the conventional Chitwood exoclamp for patients in which the exoclamp cannot be used because the ascending aorta cannot be safely mobilised.
微创二尖瓣手术是许多中心的标准治疗方法，通常需要体外循环。传统的体外主动脉夹闭（外夹闭）并非总是可行，因此腔内主动脉夹闭（内夹闭）已成为一种可行的替代方法。本研究旨在比较微创二尖瓣手术中使用腔内夹闭（Intraclude™，爱德华生命科学公司）和体外夹闭（Chitwood）的效果。
这项单中心研究纳入了 822 例连续接受微创二尖瓣手术的患者。腔内夹闭组 64 例，体外夹闭组 758 例。采用倾向评分（PS）匹配，每组 63 例。观察指标包括手术过程变量、重症监护病房（ICU）和住院时间、主要不良心脏和脑血管事件（MACCE）和再次手术。
两组患者的平均年龄相似（腔内夹闭组 62.2 [岁] vs. 体外夹闭组 63.5 [岁]；p=0.554），体外循环时间（145 分钟 vs. 156 分钟；p=0.707）和手术时间（203 分钟 vs. 211 分钟；p=0.648）也相似。腔内夹闭组的 X 夹闭时间明显缩短（88 分钟 vs. 99 分钟；p=0.042）。腔内夹闭组 ICU 入住时间（25.0 小时 vs. 23.0 小时）和住院时间（10.0 天 vs. 9.0 天）稍长，但无统计学意义。两组之间的卒中、血管并发症、心肌梗死或再次二尖瓣手术的发生率虽有差异但无统计学意义。开胸转换率为 2.4%，两组间无差异。两组 7 年生存率相似（腔内夹闭组 89.9%[95%CI 85.2%94.6%]；体外夹闭组 84.0%[95%CI 79.4%88.6%]），风险比为 1.291（95%CI 0.453~3.680）。
对于无法安全移动升主动脉的患者，腔内主动脉夹闭是传统 Chitwood 体外夹闭的一种合适且相对安全的替代方法。
