This study from the Mini-Mitral International Registry (2015-2021) compared endo-aortic balloon occlusion (EABO) to transthoracic clamping (TTC) in minimally invasive mitral valve surgery. After propensity matching 733 pairs from 6,884 patients, EABO showed significantly lower rates of conversion to sternotomy, although it was associated with longer cardiopulmonary and intubation times. Mortality, stroke, bleeding, vascular complications, ICU stay, and hospital length were similar between the groups. The authors concluded that both techniques are excellent options, but EABO reduces sternotomy conversion rates.