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Publication - Dr Alexandra McAleenan

    Transthoracic clamp versus endo-aortic balloon occlusion in minimally invasive mitral valve surgery

    a systematic review and meta-analysis

    Citation

    Rival, PM, Moore, T, McAleenan, A, Hamilton, H, Du Toit, Z, Akowuah, E, Angelini, G & Vohra, H, 2019, ‘Transthoracic clamp versus endo-aortic balloon occlusion in minimally invasive mitral valve surgery: a systematic review and meta-analysis’. European Journal of Cardio-Thoracic Surgery.

    Abstract

    This systematic review and meta-analysis aims to determine outcomes following aortic occlusion with the transthoracic clamp (TTC) versus endoaortic balloon occlusion (EABO) in patients undergoing minimally invasive mitral valve surgery (MIMVS). A subgroup analysis compares TTC to EABO with femoral cannulation separately from EABO with aortic cannulation. We searched Medline and Embase up to December 2018. Two people independently and in duplicate screened title and abstracts, full-text reports, extracted data and assessed risk-of-bias (ROB) using the Cochrane ROB tool for non-randomised studies. We identified 1564 reports from which 11 observational studies with 4181 participants met the inclusion criteria. We found no evidence of difference in the risk of post-operative death or cerebrovascular accident (CVA) between the two techniques. Evidence for a reduction in aortic dissection with TTC was found: 4/1590 for the TTC group versus 19/2492 for the EABO group (RR, 0.33, 95% CI, [0.12] to [0.93], p=0.04). There was no difference in aortic cross-clamp (AoX) time between TTC and EABO (mean difference [-5.17] minutes, 95% CI, [-12.40] to [2.06], p=0.16). TTC was associated with a shorter AoX time compared to EABO with femoral cannulation (mean difference [-9.26] minutes, 95% CI, [-17.00] to [-1.52], p=0.02). EABO with aortic cannulation was associated with a shorter AoX time compared to TTC (mean difference [7.77] minutes, 95% CI, [3.29] to 12.26], p<0.001). There was no difference in cardio-pulmonary bypass (CPB) time between TTC and EABO with aortic cannulation (mean difference [-4.98] minutes, 95% CI, [-14.41] to [4.45], p=0.3). TTC was associated with a shorter CPB time compared to EABO with femoral cannulation (mean difference [-10.08] minutes, 95% CI, [-19.93] to [-0.22], p=0.05). Despite a higher risk of aortic dissection with EABO, the rates of survival and CVA across the two techniques are similar in MIMVS.

    Full details in the University publications repository