Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search and Articles Selection Strategy
2.2. Data Extraction and Endpoints
2.3. Sensitivity Analysis on Primary Endpoints
2.4. Quality and Publication Bias Assessment
2.5. Statistical Analysis
3. Results
3.1. Search Strategy and Patient Demographics
3.2. Primary Endpoints: All-Cause Mortality, CVA, and Aortic Dissection
3.3. Secondary Endpoints
3.4. Subgroup and Sensitivity Analyses
3.5. Quality and Publication Bias Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study ID, Year | Study Design | Patients, n TTC/EABO | Age, Mean ± SD TTC/EABO | Female Sex, % TTC/EABO | LVEF, Mean ± SD, TTC/EABO | NYHA Class 3/4, % TTC/EABO | Previous CVA, % TTC/EABO | Previous CS, % TTC/EABO | Type of TTC | Type of EABO Cannulation Approach | MVR:MVRe, % TTC/EABO | NOS |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Aybek, 2000 [11] | R | 35/23 | 56 ± 13/58 ± 16 | 46/52 | 61 ± 11/66 ± 13 | 3 ± 1/3 ± 1 | 3/0 | N/A | Chitwood | Heartport Endoaortic Clamp | 37:63/26:74 | 5 |
Balkhy, 2022 [12] | R-STS-A | 1163/1163 | 62 ± 12/62 ± 12 | 36/36 | EF < 30: 1/1 | 23/23 | 8/8 | 6/5 | N/A | Intraclude | 14:86/14:86 | 8 |
Barbero, 2016 [13] | R | 150/301 | 67 ± 12/P:61 ± 14 C: 69 ± 9 | 43/P: 52 C: 24 | 61 ± 10/P: 59 ± 11 C: 57 ± 13 | N/A | 11/P: 6 C: 10 | 6/P: 32 C: 25 | Chitwood | Intraclude | 38:62/40:60 | 6 |
Barbero, 2021 [14] | P | 37/80 | 62 ± 9/55 ± 12 | 30/35 | 63 ± 8/62 ± 7 | N/A | N/A | 3/10 | Chitwood | Intraclude | 10:90/21:79 | 6 |
Bentala, 2015 [15] | R | 57/164 | 62 (57–73)/66 (60–74) | 44/44 | EF < 30: 9/4 | NYHA III: 54/52 | 7/2 | N/A | Chitwood | Intraclude | 16:84/9:91 | 6 |
Ergi, 2023 [16] | P-A | 168/56 | 65 (56–70)/66 (55–72) | 32/27 | 63 (59–65)/61.5 (59–65) | 17/17 | 0/0 | N/A | Chitwood | IntraClude | N/A | 8 |
Glower, 2010 [17] | R | 436/235 | 59 ± 13/58 ± 14 | 53/59 | 51 ± 12/53 ± 10 | 72/56 | N/A | 20/14 | Cosgrove | Intraclude | 22:78/33:67 | 6 |
Grazioli, 2022 [18] | R-A | 78/102 | 60 ± 14/6 ± 12 | 35/49 | 58 ± 6/56 ± 8 | 31/48 | N/A | N/A | Chitwood, Cygnet | Intraclude | 14:86/23:77 | 7 |
Ius, 2009 [19] | R-A | 95/32 | 62 ± 11/63 ± 9 | 49/59 | 65 ± 8/64 ± 8 | 26/22 | N/A | N/A | Cygnet, Portaclamp, Chitwood | Intraclude | 23:77/41:59 | 7 |
Loforte, 2010 [20] | R * | 93/45 | 59 ± 8/58 ± 11 | 73/78 | 60 ± 10/58 ± 9 | 40/40 | N/A | 0/0 | Cygnet | Intraclude | 77:23/73:27 | 6 |
Malvindi, 2018 [21] | R * | 165/93 | 63 ± 13/56 ± 15 | 47/51 | 55 ± 7/55 ± 9 | N/A | N/A | N/A | N/A | N/A | 30:70/42:58 | 6 |
Maselli, 2006 [22] | P | 16/20 | 55 ± 5/57 ± 6 | 63/70 | N/A | N/A | N/A | N/A | Chitwood | Intraclude | 38:62/45:55 | 6 |
Mazine, 2013 [23] | R * | 103/140 | 62 ± 11/55 ± 2 | 39/40 | 61 ± 9/61 ± 8 | 32/31 | 6/6 | 3/7 | Chitwood | N/A | 13:87/20:80 | 6 |
Modi, 2009 [24] | P | 573/479 | 61 ± 14 | 51 | N/A | N/A | N/A | 7/15 | N/A | N/A | 20:80/15:85 | 6 |
Reichenspurner, 2005 [25] | R | 60/60 | 62 ± 11 | 71 | 56 ± 16 | N/A | N/A | N/A | Chitwood | Intraclude | 33:67 | 5 |
Yost, 2023 [26] | R | 42/71 | 62 (56–69)/65 (56–72) | 40/30 | N/A | N/A | 7/11 | N/A | Chitwood | IntraClude | 2:98/9:91 | 6 |
Baseline Characteristics | Arms | OR * | 95% CI | p-Value | Heterogeneity | |
---|---|---|---|---|---|---|
I2 | p-Value | |||||
Age | 14 | 0.21 | −1.5, 1.93 | 0.81 | 90% | <0.01 |
Female ratio | 14 | 0.92 | 0.82, 0.73 | 0.15 | 0% | 0.82 |
LVEF | 10 | 0.55 | −0.49, 1.59 | 0.30 | 63% | <0.01 |
NYHA III/IV | 8 | 1.08 | 0.80, 1.47 | 0.06 | 66% | <0.01 |
Previous CVA | 7 | 1.04 | 0.79, 1.36 | 0.80 | 0% | 0.57 |
Previous CS | 8 | 0.45 | 0.22, 0.91 | 0.03 | 88% | <0.01 |
MVR rate | 15 | 0.83 | 0.65, 1.05 | 0.12 | 55% | <0.01 |
Endpoints | Arms | OR * | 95% CI | p-Value | Heterogeneity | |
---|---|---|---|---|---|---|
I2 | p-Value | |||||
Total cohort | ||||||
All-cause mortality | 16 | 1.33 | 0.85, 2.07 | 0.21 | 0% | 0.58 |
CPB time | 17 | −1.68 | −8.21, 4.85 | 0.61 | 95% | <0.01 |
Aortic cross-clamp time | 16 | −3.27 | −7.61, 1.07 | 0.14 | 92% | <0.01 |
Conversion to sternotomy | 14 | 0.51 | 0.19, 1.39 | 0.19 | 65% | <0.01 |
Aortic dissection | 15 | 0.51 | 0.20, 1.33 | 0.17 | 0% | 0.50 |
CVA | 15 | 0.68 | 0.44, 1.04 | 0.07 | 0% | 0.59 |
Re-exploration | 14 | 0.90 | 0.64, 1.28 | 0.57 | 0% | 0.61 |
Ventilation | 8 | −0.03 | −0.58, 0.52 | 0.92 | 0% | 0.71 |
New onset AF | 10 | 0.86 | 0.61, 1.21 | 0.37 | 54% | 0.03 |
AKI | 11 | 1.22 | 0.91, 1.65 | 0.19 | 0% | 0.85 |
ICU stay | 10 | −0.27 | −0.72, 0.19 | 0.25 | 97% | <0.01 |
LOS | 15 | −0.20 | −0.99, 0.58 | 0.61 | 99% | <0.01 |
Femoral cannulation EABO | ||||||
All-cause mortality | 14 | 1.44 | 0.91, 2.28 | 0.12 | 0% | 0.71 |
CPB time | 14 | −3.78 | −9.84, 2.28 | 0.22 | 94% | <0.01 |
Aortic cross-clamp time | 13 | −5.60 | −10.47, −0.73 | 0.02 | 93% | <0.01 |
Conversion to sternotomy | 14 | 0.52 | 0.19, 1.40 | 0.20 | 65% | <0.01 |
Aortic dissection | 14 | 0.51 | 0.20, 1.33 | 0.17 | 0% | 0.50 |
CVA | 15 | 0.66 | 0.43, 1.02 | 0.06 | 0% | 0.65 |
Re-exploration | 13 | 0.87 | 0.61, 1.24 | 0.45 | 0% | 0.59 |
Ventilation | 7 | −0.04 | −0.59, 0.51 | 0.89 | 0% | 0.64 |
New onset AF | 9 | 1.12 | 0.93, 1.35 | 0.22 | 0% | 0.44 |
AKI | 10 | 1.27 | 0.93, 1.72 | 0.13 | 0% | 0.88 |
ICU stay | 9 | −0.30 | −0.78, 0.18 | 0.22 | 98% | <0.01 |
LOS | 13 | −0.20 | −1.17, 0.77 | 0.69 | 99% | <0.01 |
Aortic cannulation EABO | ||||||
All-cause mortality | 2 | 1.51 | 0.72, 3.14 | 0.21 | N/A | − |
CPB time | 3 | 10.07 | −35.55, 55.49 | 0.66 | 98% | <0.01 |
Aortic cross-clamp time | 3 | 7.89 | 3.65, 12.12 | <0.01 | 0% | 0.42 |
Conversion to sternotomy | 2 | 0.14 | 0.01, 3.44 | 0.23 | N/A | − |
Aortic dissection | 2 | N/E | − | − | − | − |
CVA | 2 | 3.01 | 0.15, 59.20 | 0.47 | N/A | − |
Re-exploration | 2 | 1.60 | 0.51, 4.97 | 0.42 | 0% | 0.75 |
Ventilation | 1 | 2.60 | −6.73, 11.93 | 0.58 | N/A | − |
New onset AF | 1 | 0.45 | 0.27, 0.76 | <0.01 | N/A | − |
AKI | 2 | 0.73 | 0.25, 2.08 | 0.13 | 0% | 0.88 |
ICU stay | 1 | 0.10 | −0.70, 0.90 | 0.81 | N/A | − |
LOS | 2 | 0.00 | −0.10, 0.10 | 0.99 | 0% | 0.40 |
Video-assisted approach | ||||||
All-cause mortality | 12 | 1.18 | 0.67, 2.08 | 0.57 | 0% | 0.48 |
CPB time | 13 | −4.85 | −14.51, 4.80 | 0.32 | 94% | <0.01 |
Aortic cross-clamp time | 12 | −5.41 | −11.54, 0.72 | 0.08 | 89% | <0.01 |
Conversion to sternotomy | 10 | 0.31 | 0.16, 0.61 | <0.01 | 0% | 0.69 |
Aortic dissection | 11 | 0.39 | 0.14, 1.13 | 0.08 | 0% | 0.45 |
CVA | 11 | 0.55 | 0.31, 0.98 | 0.04 | 0% | 0.52 |
Re-exploration | 12 | 0.87 | 0.61, 1.23 | 0.43 | 0% | 0.43 |
Ventilation | 8 | −0.03 | −0.58, 0.52 | 0.92 | 0% | 0.71 |
New onset AF | 8 | 0.77 | 0.52, 1.14 | 0.19 | 37% | 0.14 |
AKI | 10 | 1.08 | 0.59, 1.97 | 0.81 | 0% | 0.79 |
ICU stay | 8 | −0.07 | −0.09, −0.05 | <0.01 | 0% | 0.88 |
LOS | 12 | −0.40 | −1.36, 0.57 | 0.42 | 99% | <0.01 |
Robotic-assisted approach | ||||||
All-cause mortality | 2 | 5.17 | 0.21, 129.80 | 0.32 | N/A | − |
CPB time | 2 | 13.68 | 7.31, 20.05 | <0.01 | 94% | <0.01 |
Aortic cross-clamp time | 2 | 4.46 | −4.36, 13.28 | 0.32 | 98% | <0.01 |
Conversion to sternotomy | 2 | 1.71 | 0.10, 280.03 | 0.71 | N/A | − |
Aortic dissection | 2 | 1.01 | 0.04, 25.20 | 0.99 | N/A | − |
CVA | 2 | 0.55 | 0.02, 13.88 | 0.72 | N/A | − |
Re-exploration | 2 | 5.38 | 0.54, 53.54 | 0.15 | N/A | − |
Ventilation | 0 | − | − | − | − | − |
New onset AF | 1 | 1.38 | 0.49, 3.86 | 0.54 | N/A | − |
AKI | 0 | − | − | − | − | − |
ICU stay | 0 | − | − | − | − | − |
LOS | 1 | 0.00 | −0.14, 0.14 | 1.00 | N/A | − |
Risk-Adjusted Total Cohort | ||||||
All-cause mortality | 4 | 1.64 | 0.80, 3.34 | 0.18 | 0% | 0.35 |
CPB time | 4 | 0.51 | −9.03, 10.06 | 0.92 | 89% | <0.01 |
Aortic cross-clamp time | 4 | −3.84 | −9.16, 1.49 | 0.16 | 81% | <0.01 |
Conversion to sternotomy | 4 | 0.51 | 0.05, 5.54 | 0.58 | 84% | <0.01 |
Aortic dissection | 4 | 0.90 | 0.14, 5.93 | 0.91 | 29% | 0.24 |
CVA | 4 | 0.71 | 0.35, 1.44 | 0.34 | 7% | 0.34 |
Re-exploration | 3 | 1.03 | 0.04, 25.96 | 0.98 | N/A | − |
Ventilation | 2 | −5.77 | −19.75, 8.21 | 0.42 | 58% | 0.12 |
New onset AF | 4 | 1.18 | 0.97, 1.44 | 0.10 | 0% | 0.50 |
AKI | 4 | 1.33 | 0.96, 1.84 | 0.09 | 0% | 0.39 |
ICU stay | 4 | −0.50 | −1.28, 0.28 | 0.21 | 99% | <0.01 |
LOS | 4 | 0.30 | −0.60, 1.21 | 0.51 | 95% | <0.01 |
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Magouliotis, D.E.; Sicouri, S.; Baudo, M.; Yamashita, Y.; Xanthopoulos, A.; Arjomandi Rad, A.; Athanasiou, T.; Ramlawi, B. Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses. J. Clin. Med. 2024, 13, 4989. https://doi.org/10.3390/jcm13174989
Magouliotis DE, Sicouri S, Baudo M, Yamashita Y, Xanthopoulos A, Arjomandi Rad A, Athanasiou T, Ramlawi B. Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses. Journal of Clinical Medicine. 2024; 13(17):4989. https://doi.org/10.3390/jcm13174989
Chicago/Turabian StyleMagouliotis, Dimitrios E., Serge Sicouri, Massimo Baudo, Yoshiyuki Yamashita, Andrew Xanthopoulos, Arian Arjomandi Rad, Thanos Athanasiou, and Basel Ramlawi. 2024. "Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses" Journal of Clinical Medicine 13, no. 17: 4989. https://doi.org/10.3390/jcm13174989