Comment
The development of minimally invasive mitral surgical approaches and the
concomitant anesthetic upskilling that has been required has resulted in
a broader range of tools at the disposal of cardiac surgical teams
approaching cases such as these. Advantages of using the endoballoon in
this setting are shorter DHCA time, excellent myocardial protection and
complete decompression of the left ventricle during re-entry. Whilst
this approach has been reported in several other publications, this case
is unique due to the added complication of patent coronary grafts (4).
Pre-procedural CT imaging was utilized to identify an anatomical
landmark which could be used on TEE to position the endoballoon relative
to the patent grafts. The approach facilitated an excellent recovery.
Knowledge of the balloon length is critical for precise placement and
identification of a ‘landing zone’ during cases with patent proximal
coronary anastomoses. We believe the endoballoon strategy is easily
replicated in centers with an active minimally invasive cardiac surgical
program.