{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:46:55Z","timestamp":1793119615475,"version":"4.5.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T00:00:00Z","timestamp":1681344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Median age was 65\u2009years (57% male). Median EuroSCORE II was 1.3% (Inpatient Quality Reporting (IQR): 0.80\u20132.63). 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\u2009min (IQR: 107\u2013173) and 85\u2009min (IQR: 64\u2013111), 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\u2009&amp;lt;\u20090.001). Age, low ejection fraction and emergent surgery were risk factors, but variables of \u2018increased complexity\u2019 (redo, endocarditis, concomitant procedures) were not.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezad147","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T15:36:12Z","timestamp":1681400172000},"source":"Crossref","is-referenced-by-count":33,"title":["Aortic cross-clamp time correlates with mortality in the mini-mitral international registry"],"prefix":"10.1093","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-909X","authenticated-orcid":false,"given":"Torsten","family":"Doenst","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital , Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Berretta","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche , Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7656-5812","authenticated-orcid":false,"given":"Nikolaos","family":"Bonaros","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Innsbruck , Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Savini","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Sant\u2019Orsola Malpighi Hospital, University of Bologna , Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-7886","authenticated-orcid":false,"given":"Antonios","family":"Pitsis","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, European Interbalkan Medical Center , Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3382-1142","authenticated-orcid":false,"given":"Manuel","family":"Wilbring","sequence":"additional","affiliation":[{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden , Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Gerdisch","sequence":"additional","affiliation":[{"name":"Franciscan Health Indianapolis , Indianapolis, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorg","family":"Kempfert","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, University of Turin , Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Folliguet","sequence":"additional","affiliation":[{"name":"Henri Mondor Hospital, University of Paris , Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6975-8149","authenticated-orcid":false,"given":"Tristan","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital , Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Stefano","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Careggi University Hospital , Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Van Praet","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Hartcentrum OLV Aalst , Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loris","family":"Salvador","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, S. Bortolo Hospital , Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lamelas","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of Miami , Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom C","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School , Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Hoang","family":"Dinh","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy , Ho Chi Minh City, Viet Nam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2153-2458","authenticated-orcid":false,"given":"Gloria","family":"F\u00e4rber","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Jena University Hospital , Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Di Eusanio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche , Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,4,13]]},"reference":[{"key":"2023060914152208100_ezad147-B1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1055\/s-0042-1754353","article-title":"German Heart Surgery Report 2021: the Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"70","author":"Beckmann","year":"2022","journal-title":"Thorac Cardiovasc Surg"},{"key":"2023060914152208100_ezad147-B2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1510\/icvts.2009.203448","article-title":"Is a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?","volume":"9","author":"Murzi","year":"2009","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2023060914152208100_ezad147-B3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/imi.0b013e318216be5c","article-title":"Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010","volume":"6","author":"Falk","year":"2011","journal-title":"Innovations (Phila)"},{"key":"2023060914152208100_ezad147-B4","first-page":"613","article-title":"Do we have enough evidence for minimally-invasive cardiac surgery? 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