VALUE AND SAFETY OF FEMORAL ARTERY CANNULATION FOR CARDIAC SURGERY

Objective To delineate the efficacy and safety of transthoracic cannulation to the ascending aorta through a right pleural cavity during minimally invasive cardiac surgery (MICS). Methods We retrospectively assessed the records of 104 patients who underwent MICS in our institution between December 2011 and December 2018. Procedures included mitral valve repair (88 patients), aortic valve replacement (8 patients), atrial septal defect closure (6 patients), and myxoma resection (2 patients). Aortic valve replacements were performed through the third intercostal space (ICS), whereas the other procedures were mainly performed through the fourth ICS. The femoral group comprised 60 patients in whom an artificial graft was anastomosed to the femoral artery and 4 who underwent cannulation into the femoral artery. The aorta group comprised 40 patients in whom transthoracic cannulation was performed through the second or third ICS, separate from the main skin incision. Results No mortality or critical complications were associated with cardiopulmonary bypass. Perfusion pressure measured at outflow of the artificial lung (224 ± 43 vs. 190 ± 42; P < 0.001) and pump pressure measured at the outflow of the pump (293 ± 50 vs. 255 ± 57; P < 0.001) were significantly higher in the femoral group than in the aorta group. The skin incision lengths were similar (56.9 ± 6.9 vs. 55.1 ± 6.0 mm; P = 0.107). Conclusions Transthoracic cannulation into the ascending aorta is reliable and can be safely performed. The possible risks associated with peripheral cannulation and retrograde perfusion can be avoided thereafter.

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Peripheral vascular complications following totally endoscopic cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01417-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ling-chen Huang ◽

Qi-chen Xu ◽

Dao-zhong Chen ◽

Xiao-fu Dai ◽

Liang-wan Chen

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Femoral Artery ◽

Femoral Vein ◽

Vascular Complications ◽

Minimally Invasive Cardiac Surgery ◽

Venous Cannulation ◽

Artery Cannulation ◽

Short Period

Abstract Background Clinical application of minimally invasive cardiac surgery has increased annually. Cardiopulmonary bypass is established by peripheral cannulation during minimally invasive cardiac surgery. The methodology of peripheral cannulation has unique characteristics, which have associated risks and complications. Few studies have been conducted on this topic. In this study, we focused on complications of peripheral cannulation in totally endoscopic cardiac surgery. Methods Patients who underwent totally endoscopic cardiac surgery with cardiopulmonary bypass established by peripheral cannulation at our institution between January 2019 and June 2020 were reviewed. Specific cannulation strategies and related cannulation complications were noted. Results One hundred forty-eight patients underwent totally endoscopic cardiac surgery. One hundred forty-eight cannulations were performed in the femoral artery and vein, and eleven were performed in the internal jugular vein (combined with the femoral vein). The median size of the femoral artery cannula was 22Fr, and that of the venous canula was 24Fr. One patient died of retroperitoneal haematoma due to femoral artery injury. Three patients had postoperative lower limb oedema. One patient had a postoperative diagnosis of femoral vein thrombosis. Conclusions Different from cannulation in patients with aortic dissection and aneurysms, femoral artery cannulation is safe in totally endoscopic cardiac surgery. Venous cannulation is characterized by a large-bore venous cannula and a short period of use. There are few reports about complications of venous cannulation. The main complication in this study was mechanical injury, and the key to preventing this injury is meticulous manipulation during surgery.

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Minimally Invasive Valve Replacement: Surgical Disasters Might Also be Expected

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239800600115 ◽

1998 ◽

Vol 6 (1) ◽

pp. 60-61 ◽

Cited By ~ 1

Author(s):

Carlos-A Mestres ◽

Norberto Cassinello ◽

Manuel Fuentes

Keyword(s):

Cardiac Surgery ◽

Patient Satisfaction ◽

Clinical Practice ◽

Aortic Dissection ◽

Minimally Invasive ◽

Femoral Artery ◽

Length Of Hospital Stay ◽

Surgical Trauma ◽

Artery Cannulation ◽

Usual Clinical Practice

Minimally invasive cardiac surgery is rapidly gaining popularity. Diminishing surgical trauma by using smaller incisions seems to achieve the goal of a shorter length of hospital stay with reduced cost, better cosmetic results, and overall patient satisfaction. Therefore, a number of advantages can be anticipated, especially in selected patients. However, surgical complications might also be expected. The case of a 54-year-old male suffering intraoperative aortic dissection due to femoral artery cannulation illustrates the fact that we must be very careful when introducing any modification to the usual clinical practice.

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Comparison of ultrasound-guided femoral artery cannulation versus palpation technique in neonates undergoing cardiac surgery

The Journal of Vascular Access ◽

10.1177/11297298211023307 ◽

2021 ◽

pp. 112972982110233

Author(s):

Fikret Salık ◽

Mustafa Bıçak

Keyword(s):

Cardiac Surgery ◽

Success Rate ◽

Femoral Artery ◽

Access Time ◽

Ultrasound Guided ◽

Cost Analyses ◽

Artery Cannulation ◽

The Cost ◽

Ultrasound Group

Objectives: Palpation technique for femoral artery cannulation can be very difficult, especially in neonates. In this study, we evaluated whether ultrasound-guided cannulation of the femoral artery is superior to palpation technique in neonates undergoing cardiac surgery. Methods: Forty neonates undergoing cardiac surgery were prospectively randomized into two groups (Ultrasound group and Palpation group). Access time, number of attempts, number of successful cannulations on first attempt, success rate, number of cannulas used, inadvertent access, and complications were compared between the two groups. Cost analyses of the cannulation were performed in two groups. Results: In the ultrasound group, access time for femoral artery cannulation was shorter (6.4 ± 3.0 and 10.2 ± 4.4, p = 0.003) and the number of attempts (1.4 ± 0.6 and 2.3 ± 0.8, p < 0.001) was lower compared to the palpation group. The number of successful cannulations on first-attempt (15 (75%) and 5 (25%), p = 0.002) and the success rate (95% (19) and 60% (12), p = 0.008) were higher in the ultrasound group. The number of cannulas used in the ultrasound group was less than the palpation group ( p = 0.001). The cost of intervention was higher in the palpation group compared to the ultrasound group ( p = 0.048). Conclusions: The ultrasound-guided cannulation of the femoral artery in neonates is superior to the palpation technique based on the increased of the number of successful first-attempt cannulation and success rate, and the reducing of the access time, number of attempts, number of cannulas used, and cost of cannulation.

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A Phase 1 Study of a Novel Bidirectional Perfusion Cannula in Patients Undergoing Femoral Cannulation for Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000489 ◽

2018 ◽

Vol 13 (2) ◽

pp. 97-103 ◽

Cited By ~ 1

Author(s):

Silvana F. Marasco ◽

Elli Tutungi ◽

Shirley A. Vallance ◽

Andrew A. Udy ◽

Justin C. Negri ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Doppler Ultrasound ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Lower Limb ◽

Percutaneous Technique ◽

Arterial Cannulation ◽

Artery Cannulation ◽

Distal Perfusion

Objective Leg ischemia is a serious complication of femoral artery cannulation. The primary aim of this study was to assess the safety and efficacy of a novel bidirectional femoral arterial cannula (Sorin Group USA, a wholly owned subsidiary of LivaNova PLC, Arvada, CO USA) that provides both antegrade and retrograde flow, in patients undergoing peripheral cannulation for cardiopulmonary bypass during cardiac surgery. Methods Patients undergoing routine cardiac surgery requiring femoral artery cannulation for cardiopulmonary bypass were identified preoperatively. Informed written consent was obtained in all cases. Bidirectional cannula insertion used either a surgical cut-down and wire through needle approach or a percutaneous technique. Flow in the superficial femoral artery was assessed using Doppler ultrasound after commencement of cardiopulmonary bypass. Lower limb perfusion was assessed using reflectance near-infrared spectroscopy to measure regional oxygen saturations in the cannulated limb during cardiopulmonary bypass. Results Fifteen patients (median age = 61.3 years, range = 26–79 years, 10 males, 5 females) underwent femoral arterial cannulation using the novel bidirectional femoral cannula between August 2016 and May 2017. Fourteen cannulae were inserted directly into the femoral artery via a surgical cut-down and wire through needle technique. One bidirectional cannula was inserted using a percutaneous insertion technique. Indications included minimally invasive mitral and aortic valve surgery, thoracic aortic aneurysm repair, and redo cardiac surgery. The median duration of cardiopulmonary bypass was 129 minutes (range = 53–228 minutes). The cannula was inserted and positioned without difficulty in 14 of 15 patients. Incorrect sizing and arterial spasm prevented correct cannula positioning in one patient. Antegrade flow in the superficial femoral artery was observed on Doppler ultrasound in 12 of 12 patients in which this was performed. Continuous stable distal perfusion was demonstrated in the cannulated limb in 14 of 15 patients. No procedural complications occurred in the immediate or convalescent postoperative period. Conclusions This study demonstrates that in patients undergoing femoral arterial cannulation for cardiopulmonary bypass during cardiac surgery, the use of a novel bidirectional cannula is safe and easy to insert and provides stable distal perfusion of the cannulated limb. Use of the device should largely obviate the need to insert a separate downstream perfusion cannula or use other techniques to protect against lower limb ischemia. Further research on a larger scale and in different patient populations is now warranted.

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Ascending aorta cannulation in totally thoracoscopic minimally invasive cardiac surgery

10.22541/au.160595294.49123432/v1 ◽

2020 ◽

Author(s):

Shengjie Liao ◽

Xiaoshen Zhang

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Femoral Artery ◽

Extracorporeal Circulation ◽

Ascending Aorta ◽

Minimally Invasive Cardiac Surgery ◽

Artery Cannulation ◽

Aortic Cannulation ◽

Alternative Approach

The Cannulation through the femoral artery is the preferred method of establishing peripheral extracorporeal circulation in totally thoracoscopic minimally invasive cardiac surgery (MICS). However, facing to contraindications of femoral artery cannulation, a modified aortic cannulation is an alternative approach for totally thoracoscopic MICS.

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Liberal use of axillary artery cannulation for aortic and complex cardiac surgery

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt056 ◽

2013 ◽

Vol 16 (6) ◽

pp. 755-758 ◽

Cited By ~ 16

Author(s):

L. S. Fong ◽

L. Bassin ◽

M. N. Mathur

Keyword(s):

Cardiac Surgery ◽

Axillary Artery ◽

Artery Cannulation

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Femoral artery cannulation combined with axillary artery cannulation is safe for Stanford type A aortic dissection

10.21203/rs.3.rs-55538/v1 ◽

2020 ◽

Author(s):

Ling-chen Huang ◽

Qi-chen Xu ◽

Dao-zhong Chen ◽

Xiao-fu Dai ◽

Liang-wan Chen

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Femoral Artery ◽

Axillary Artery ◽

Type A ◽

Clinical Results ◽

Type A Aortic Dissection ◽

Artery Cannulation ◽

Surgical Data ◽

Perfusion Time

Abstract Background The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to the patients’ survival, but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our center used femoral and axillary artery cannulation for Stanford type A aortic dissection. The purpose of this study was to review and clarify the clinic outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of type A aortic dissection. Methods We performed a retrospective study that included 327 patients who were surgically treated for type A aortic dissection in our institution from January 2017 to June 2019.Using femoral and axillary artery cannulation to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographics data and surgical data, clinical results of the patients were calculated. Results Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. The cardiopulmonary bypass time was 141.60 ± 34.89 minutes, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 minutes. The early mortality was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had post-operative renal insufficiency and five patients with liver failure. Two patients ended up with paraplegia. Conclusion Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly reduce the occurrence of malperfusion syndrome and nervous system complications, especially for cerebral protection.

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