Minimally Invasive Valve Replacement: Surgical Disasters Might Also be Expected

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 the Efficacy of Transthoracic Cannulation into the Ascending Aorta Versus Femoral Artery Cannulation in Minimally Invasive Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519879123 ◽

2019 ◽

Vol 14 (6) ◽

pp. 537-544

Author(s):

Hiroyuki Nakajima ◽

Akitoshi Takazawa ◽

Chiho Tounaga ◽

Akihiro Yoshitake ◽

Masato Tochii ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Valve ◽

Minimally Invasive ◽

Femoral Artery ◽

Skin Incision ◽

Ascending Aorta ◽

Minimally Invasive Cardiac Surgery ◽

Atrial Septal Defect Closure ◽

Artery Cannulation ◽

Artificial Graft

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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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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Arterial Injuries from Femoral Artery Cannulation with Port Access Cardiac Surgery

Vascular and Endovascular Surgery ◽

10.1177/153857440503900204 ◽

2005 ◽

Vol 39 (2) ◽

pp. 153-158 ◽

Cited By ~ 33

Author(s):

Bart E. Muhs ◽

Aubrey C. Galloway ◽

Michael Lombino ◽

Michael Silberstein ◽

Eugene A. Grossi ◽

...

Keyword(s):

Cardiac Surgery ◽

Femoral Artery ◽

Artery Cannulation ◽

Arterial Injuries ◽

Port Access

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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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Pressure difference between radial and femoral artery pressure in minimally invasive cardiac surgery using retrograde perfusion

The International Journal of Artificial Organs ◽

10.1177/0391398818784791 ◽

2018 ◽

Vol 41 (10) ◽

pp. 635-643 ◽

Cited By ~ 2

Author(s):

Yoshitsugu Nakamura ◽

Sam Emmanuel ◽

Fumiaki Shikata ◽

Chihiro Shirai ◽

Yujiro Ito ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Arterial Pressure ◽

Minimally Invasive ◽

Femoral Artery ◽

Systolic Arterial Pressure ◽

Minimally Invasive Cardiac Surgery ◽

Pressure Differential ◽

Artery Pressure ◽

Retrograde Perfusion

Objective: To investigate whether radial artery pressure is a reliable surrogate measure of central arterial pressure as approximated by femoral artery pressure in minimally invasive cardiac surgery with retrograde perfusion via femoral cannulation. Method: Fifty-two consecutive patients undergoing minimally invasive cardiac surgery were prospectively included in this study. Cardiopulmonary bypass was established via a femoral artery cannulation and femoral vein. Radial and femoral arterial pressures were recorded continuously, and the pressure differential between them was calculated for both systolic and mean arterial pressures. The agreement between measurements from the two arteries was compared using Bland–Altman plots. An interval of 95% limits of agreement of less than 20 mm Hg was set as satisfactory agreement. Results: Average age was 65 ± 14 years. With respect to systolic arterial pressure, 28 patients (54%) had a peak pressure differential between radial and femoral arteries ⩾20 mm Hg. With respect to mean arterial pressure, only five patients (9%) had a peak pressure differential ⩾20 mm Hg. The pressure differential changed with time. Pressure differential in systolic arterial pressure was 5 ± 8 mm Hg until aortic declamping, then increased to a peak of 23 ± 16 mm Hg when cardiopulmonary bypass was turned off. The femoral systolic arterial pressures were significantly greater than radial systolic arterial pressures from time of aortic declamping to 20 min after cardiopulmonary bypass. The Bland–Altman plots revealed large biases and poor agreement in this period. Conclusion: Radial and femoral systolic artery pressure readings can differ significantly in minimally invasive cardiac surgery with retrograde perfusion. Intraoperative arterial pressure management based solely on radial systolic arterial pressure readings should be avoided.

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Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000540 ◽

2018 ◽

Vol 13 (4) ◽

pp. 300-304 ◽

Cited By ~ 2

Author(s):

Vivek A. Wadhawa ◽

Kartik G. Patel ◽

Chirag P. Doshi ◽

Jigar K. Shah ◽

Jaydip A. Ramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Superior Vena Cava ◽

Femoral Artery ◽

Superior Vena ◽

Femoral Vein ◽

Vena Cava ◽

Pediatric Cardiac Surgery

Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

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