PMID- 37052525 OWN - NLM STAT- MEDLINE DCOM- 20230608 LR - 20230803 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 63 IP - 6 DP - 2023 Jun 1 TI - Aortic cross-clamp time correlates with mortality in the mini-mitral international registry. LID - ezad147 [pii] LID - 10.1093/ejcts/ezad147 [doi] AB - OBJECTIVES: Minimally invasive access has become the preferred choice in mitral and/or tricuspid valve surgery. Reported outcomes are at least similar to classic sternotomy although aortic cross-clamp times are usually longer. METHODS: We analysed the largest registry of mitral and/or tricuspid valve surgery patients (mini-mitral international registry (MMIR)) for the relationship between aortic cross-clamp times, mortality and other outcomes. From 2015 to 2021, 7513 consecutive patients underwent mini-mitral and/or tricuspid valve surgery in 17 international Heart-Valve-Centres. Data were collected according to Mitral Valve Academic Research Consortium (MVARC) definitions and 6878 patients with 1 cross-clamp period were analysed. Uni- and multivariable regression analyses were used to assess outcomes in relation to aortic cross-clamp times. RESULTS: Median age was 65 years (57% male). Median EuroSCORE II was 1.3% (Inpatient Quality Reporting (IQR): 0.80-2.63). Minimally invasive access was either by direct vision (28%), video-assisted (41%) or totally endoscopic/robotic (31%). Femoral cannulation was used in 93%. Three quarters were repairs with 17% additional tricuspid valve surgery and 19% Atrial Fibrillation (AF)-ablation. Cardiopulmonary bypass and cross-clamp times were 135 min (IQR: 107-173) and 85 min (IQR: 64-111), respectively. Postoperative events were death (1.6%), stroke (1.2%), bleeding requiring revision (6%), low cardiac output syndrome (3.5%) and acute kidney injury (6.2%, mainly stage I). Statistical analyses identified significant associations between cross-clamp time and mortality, low cardiac output syndrome and acute kidney injury (all P < 0.001). Age, low ejection fraction and emergent surgery were risk factors, but variables of 'increased complexity' (redo, endocarditis, concomitant procedures) were not. CONCLUSIONS: Aortic cross-clamp time is associated with mortality as well as postoperatively impaired cardiac and renal function. Thus, implementing measures to reduce cross-clamp time may improve outcomes. CI - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Doenst, Torsten AU - Doenst T AUID- ORCID: 0000-0002-6411-909X AD - Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany. FAU - Berretta, Paolo AU - Berretta P AD - Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy. FAU - Bonaros, Nikolaos AU - Bonaros N AUID- ORCID: 0000-0002-7656-5812 AD - Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria. FAU - Savini, Carlo AU - Savini C AD - Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. FAU - Pitsis, Antonios AU - Pitsis A AUID- ORCID: 0000-0001-5745-7886 AD - Cardiac Surgery Department, European Interbalkan Medical Center, Thessaloniki, Greece. FAU - Wilbring, Manuel AU - Wilbring M AUID- ORCID: 0000-0002-3382-1142 AD - Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Dresden, Germany. FAU - Gerdisch, Marc AU - Gerdisch M AD - Franciscan Health Indianapolis, Indianapolis, IN, USA. FAU - Kempfert, Jorg AU - Kempfert J AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. FAU - Rinaldi, Mauro AU - Rinaldi M AD - Cardiac Surgery Unit, University of Turin, Turin, Italy. FAU - Folliguet, Thierry AU - Folliguet T AD - Henri Mondor Hospital, University of Paris, Paris, France. FAU - Yan, Tristan AU - Yan T AUID- ORCID: 0000-0002-6975-8149 AD - Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia. FAU - Stefano, Pierluigi AU - Stefano P AD - Cardiac Surgery Unit, Careggi University Hospital, Firenze, Italy. FAU - Van Praet, Frank AU - Van Praet F AD - Cardiac Surgery Department, Hartcentrum OLV Aalst, Aalst, Belgium. FAU - Salvador, Loris AU - Salvador L AD - Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy. FAU - Lamelas, Joseph AU - Lamelas J AD - Division of Cardiothoracic Surgery, University of Miami, Miami, FL, USA. FAU - Nguyen, Tom C AU - Nguyen TC AD - Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA. FAU - Dinh, Nguyen Hoang AU - Dinh NH AD - University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam. FAU - Farber, Gloria AU - Farber G AUID- ORCID: 0000-0002-2153-2458 AD - Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany. FAU - Di Eusanio, Marco AU - Di Eusanio M AD - Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy. LA - eng PT - Journal Article PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM CIN - Eur J Cardiothorac Surg. 2023 Jun 1;63(6):. PMID: 37255316 MH - Humans MH - Male MH - Aged MH - Female MH - Cardiac Output, Low/etiology/surgery MH - Mitral Valve/surgery MH - *Cardiac Surgical Procedures/methods MH - Aorta/surgery MH - Sternotomy/methods MH - Minimally Invasive Surgical Procedures/methods MH - Treatment Outcome MH - Thoracotomy MH - Retrospective Studies MH - *Heart Valve Prosthesis Implantation/methods OTO - NOTNLM OT - Mini-thoracotomy OT - Minimally invasive valve surgery OT - Myocardial ischemia OT - Myocardial protection EDAT- 2023/04/14 06:00 MHDA- 2023/06/08 06:42 CRDT- 2023/04/13 10:13 PHST- 2022/09/25 00:00 [received] PHST- 2023/03/20 00:00 [revised] PHST- 2023/04/12 00:00 [accepted] PHST- 2023/06/08 06:42 [medline] PHST- 2023/04/14 06:00 [pubmed] PHST- 2023/04/13 10:13 [entrez] AID - 7117546 [pii] AID - 10.1093/ejcts/ezad147 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2023 Jun 1;63(6):ezad147. doi: 10.1093/ejcts/ezad147.