Abstract：
Endoaortic balloon occlusion (EABO) and transthoracic cross-clamping have been shown to have comparable safety profiles for aortic occlusion in minimally invasive mitral valve surgery (MIMVS). However, few studies have focused exclusively on the totally endoscopic robotic approach. We sought to compare outcomes for patients undergoing totally endoscopic robotic mitral valve surgery with aortic occlusion via EABO and transthoracic clamping after a period where EABO was unavailable required us to use the transthoracic clamp. Retrospective review identified 113 patients who underwent robotic mitral valve surgery at our facility between 2019 and 2021 with EABO (n = 71) or transthoracic clamping (n = 42). Relevant data were extracted and compared. Preoperative characteristics were similar other than a higher rate of coronary artery disease [EABO: 69.0% (49/71) vs clamp: 45.2% (19/42), p = .02] and chronic lung disease [EABO: 38.0% (27/71) vs clamp: 9.5% (4/42), p < .01] in the EABO group. Median percutaneous cardiopulmonary bypass time, operative time, and cross-clamp time were comparable. Similar rates of postoperative bleeding complications were observed, and no aortic complications were observed. One patient in each group underwent conversion to an open approach. 30-day mortality and readmission rates were comparable. EABO and transthoracic clamp were associated with similar bleeding and aortic outcomes, and mortality and readmission rates were comparable at thirty days postoperatively. Our findings support the comparable safety of the two techniques, which is well documented in studies encompassing all MIMVS techniques, within the specific context of the totally endoscopic robotic approach.
摘要：
在微创二尖瓣手术（MIMVS）中，主动脉内球囊闭塞（EABO）和经胸交叉钳夹已被证明具有相当的安全性。然而,很少有研究完全集中在完全内窥镜机器人方法上。我们试图比较接受完全内窥镜机器人二尖瓣手术并通过EABO和经胸钳夹进行主动脉闭塞的患者的结局，因为EABO不可用，需要我们使用经胸钳夹。回顾性审查确定了113例患者在2019年至2021年期间在我们的机构接受了EABO（n=71）或经胸钳夹（n=42）的机器人二尖瓣手术。提取相关数据并进行比较。术前特征相似，但冠状动脉疾病的发生率较高[EABO：69.0％（49/71）vs钳夹：45.2％（19/42），p=.02]和慢性肺病[EABO：38.0％（27/71）与钳夹：9.5％（4/42），在EABO组中p<.01]。经皮体外循环中位时间,手术时间,和交叉钳夹时间具有可比性。术后出血并发症发生率相似，无主动脉并发症。每组中的一名患者接受了开放方法的转换。30天死亡率和再入院率相当。EABO和经胸钳夹术后出血和主动脉结局相似，术后30天的死亡率和再入院率相当.我们的发现支持两种技术的可比安全性，这在包括所有MIMVS技术的研究中得到了很好的证明，在完全内窥镜机器人方法的特定背景下。
