Endo-aortic balloon occlusion for reoperative minimally invasive mitral valve replacement on intra-aortic balloon pump: a case report

Minimally invasive approaches are the future of cardiac surgery. Coupled with that are devices such as endo-aortic balloon occlusion (EABO) which allow the success of such procedures. EABO has also proven invaluable in high-risk or reoperative cases. We report a severely high-risk patient who presented for reoperative minimally invasive mitral valve replacement with an intra-aortic balloon pump (IABP) and multiple high-dose vasopressors. The EABO was utilized over a transthoracic cross clamp (TCC). With careful maneuvering upon ascent into the aorta, the deflated endoballoon easily passed beyond the deflated IABP balloon under transesophageal echocardiogram (TEE) guidance. After completion of arrest, surgical placement of the bioprosthetic valve, and spontaneous return of cardiac rhythm once EABO was completed, the deflated endoballoon was carefully retracted back down through the aorta past the deflated IABP balloon. The integrity of the IABP balloon remained intact and was able to resume function once cardiopulmonary bypass (CPB) was terminated. We found that EABO was a safe and effective alternative technique for aortic occlusion in our patient supported on IABP with previous sternotomy.