scholarly journals Peripheral vascular complications following totally endoscopic cardiac surgery

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.

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

2018 ◽  
Vol 41 (10) ◽  
pp. 635-643 ◽  
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.

Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

2018 ◽  
Vol 13 (4) ◽  
pp. 300-304 ◽  
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.

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

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.

scholarly journals Ascending aorta cannulation in totally thoracoscopic minimally invasive cardiac surgery

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.

Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery

2019 ◽  
Vol 34 (8) ◽  
pp. 1280-1286
Author(s):  
Ryosuke Muraki ◽  
Toshinori Totsugawa ◽  
Kazuyuki Nagata ◽  
Kosuke Nakajima ◽  
Tomoya Oshita ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Minimally Invasive Cardiac Surgery ◽  
Cell Salvage

Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey

2012 ◽  
Vol 7 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Edward Y. Chan ◽  
Dennis M. Lumbao ◽  
Alexander Iribarne ◽  
Rachel Easterwood ◽  
Jonathan Y. Yang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Vena Cava ◽  
Minimally Invasive Cardiac Surgery ◽  
Aortic Occlusion ◽  
Complication Rates ◽  
Venous Cannulation ◽  
Arterial Cannulation ◽  
Dual Stage ◽  
Over Time

Objective For minimally invasive cardiac surgery (MICS) procedures requiring cardiopulmonary bypass (CPB), cannulation techniques vary and seem to be important determinants of technical difficulty and clinical outcomes. Over 10 years of MICS, we have modified our techniques substantially, and the present report outlines the evolution of our current cannulation platform. Methods From October 2000 to November 2010, 1087 minimally invasive cardiac procedures were performed at our institution; of these, 165 were done without CPB and were excluded. Methods of arterial and venous cannulation and aortic occlusion were retrospectively reviewed. Outcomes of interest included CPB and aortic cross-clamp time, as well as rates of in-hospital stroke, myocardial infarction, and short- and long-term mortality. Results The mean age of the study population was 57 ± 15 years, with 50% being men. The MICS procedures included mitral valve surgery, atrial septal defect repair, atrial fibrillation ablation, and cardiac tumor resections. Over the study period, peripheral arterial cannulation was replaced by central aortic cannulation, which was used in 33% of patients in 2000–2001 and 93% in 2008–2010. Venous cannulation strategies also evolved over time, from percutaneous neck and femoral (78% of cases from 2000–2005), to direct superior vena cava and percutaneous femoral (67% in 2006–2007), to percutaneous dual-stage femoral (51% in 2008–2010). Aortic occlusion was achieved by endoaortic balloon in 33% of cases in 2000–2001 but, by 2002, was replaced by transaxillary clamp occlusion and direct antegrade/retrograde cardioplegia. In the post-endoballoon era, CPB and cross-clamp times have remained consistent. Overall, there were nine strokes (<1.0%), no myocardial infarctions, and 18 deaths (2.0%) within 30 days of surgery, and the incidence of these outcomes has not changed over time. Conclusions Over 10 years, our cannulation strategy for MICS has evolved to favor central aortic over femoral arterial cannulation, percutaneous femoral dual-stage bicaval venous drainage over percutaneous neck access, and transaxillary clamping over endoaortic balloon occlusion of the aorta. In our experience, this approach has resulted in low complication rates and a reliable platform for a variety of MICS procedures.

scholarly journals Correction to: Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery

2019 ◽  
Vol 34 (8) ◽  
pp. 1287-1287
Author(s):  
Ryosuke Muraki ◽  
Toshinori Totsugawa ◽  
Kazuyuki Nagata ◽  
Kosuke Nakajima ◽  
Tomoya Oshita ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Minimally Invasive Cardiac Surgery ◽  
Cell Salvage

Clinical Experience in Minimally Invasive Cardiac Surgery with Virtually Wall-Less Venous Cannulas

2018 ◽  
Vol 13 (2) ◽  
pp. 104-107
Author(s):  
Enrico Ferrari ◽  
Ludwig K. von Segesser ◽  
Denis Berdajs ◽  
Ludwig Müller ◽  
Maximilian Halbe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Drainage ◽  
Minimally Invasive Cardiac Surgery ◽  
Thin Wall ◽  
Venous Cannulation ◽  
Pump Speed ◽  
Surgical Field

Objective Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS) is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed. The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS. Methods Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530–630-mm ST) was performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3), and other (4) procedures (combinations possible). Before transfemoral insertion of wall-less cannulas, a guidewire was positioned in the superior vena cava under echocardiographic control. The wall-less cannula was then fed over the wire and connected to a minimal extracorporeal system. Vacuum assist was used to reach a target flow of 2.4 l/min per m2 with augmented venous drainage at less than −80 mm Hg. Results Wall-less venous cannulas measuring either 630 mm (n = 8) in length or 530 mm (n = 2) were successfully implanted in all patients. For a body size of 173 ± 11 cm and a body weight of 78 ± 26 kg, the calculated body surface area was 1.94 ± 0.32 m2. As a result, the estimated target flow was 4.66 ± 0.78 l/min, whereas the achieved flow accounted for 4.98 ± 0.69 l/min (107% of target) at a vacuum level of 21.3 ± 16.4 mm Hg. Excellent exposure and “dry” intracardiac surgical field resulted. Conclusions The performance of virtually wall-less venous cannulas designed for augmented peripheral venous drainage was tested in MICS and provided excellent flows at minimal vacuum levels, confirming an increased performance over traditional thin wall cannulas. Superior results can be expected for routine use.

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