Femoral cannulation for cardiopulmonary bypass with a novel bidirectional perfusion cannula

Mapping Intimacies ◽

10.1510/mmcts.2021.047 ◽

2021 ◽

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Femoral Artery ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

The Novel ◽

Postoperative Course ◽

Video Tutorial ◽

Percutaneous Cannulation

The use of the novel bidirectional femoral cannula is described in this video tutorial. We demonstrate the percutaneous cannulation and decannulation of the femoral artery for cardiopulmonary bypass in a patient undergoing minimally invasive mitral valve surgery. The procedure itself is presented step by step for each important phase. Finally, we report the postoperative course following the successful use of a peripheral bidirectional cannula.

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Robotic Mitral Valve Surgery and Unilateral Pulmonary Edema

Cardiothoracic Critical Care ◽

10.1093/med/9780190082482.003.0017 ◽

2020 ◽

pp. 171-178

Author(s):

Cindy Cheung ◽

Christopher W. Tam

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Pulmonary Edema ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Blood Product Transfusion ◽

Unilateral Pulmonary Edema ◽

Less Invasive Approach ◽

The Difference

This chapter describes robotic or minimally invasive mitral valve surgery, which was pioneered in 1998 to be the less invasive approach to sternotomy-based mitral valve operations. Patients undergoing robotic valve surgery carry a similar risk of complications that may occur with traditional median sternotomy surgery, but minimally invasive valve surgery has its own inherent complications associated with cardiac access, perfusion, and ventilation methods used in robotic surgeries. Unilateral pulmonary edema (UPE) is an uncommon but potentially life-threatening complication of robotic mitral valve surgery. The incidence of unilateral lung injury, which commonly manifests as UPE, has been reported to be quite variable. The variation in incidence could be related to the difference in patient populations, diagnostic criteria, as well as management. Moreover, the pathophysiology of UPE associated with robotic mitral valve repair remains unclear. The current literature suggests that UPE can be prevented by shorter cardiopulmonary bypass times, avoiding barotrauma, limiting blood product transfusion, and minimizing lung isolation times. Lung preventive ventilation, such as low-level positive pressure and frequent alveolar recruitment, while on cardiopulmonary bypass may be beneficial. Meanwhile, treatment for UPE is dependent on the severity of symptoms.

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Relationship of Cardiopulmonary Bypass Times and Outcomes in Minimally Invasive Mitral Valve Surgery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2021.01.019 ◽

2021 ◽

Author(s):

Mark R. Helmers ◽

Samuel T. Kim ◽

Pavan Atluri

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Relationship Of

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Long-term results of endoclamping in patients undergoing minimally invasive mitral valve surgery where external aortic clamping cannot be used – a propensity matched analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01363-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ayse Cetinkaya ◽

Emad Ebraheem ◽

Karin Bramlage ◽

Stefan Hein ◽

Peter Bramlage ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Hospital Stay ◽

Statistical Significance ◽

Vascular Complications ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Long Term Results ◽

Aortic Clamping

Abstract Background Minimally invasive mitral valve surgery is standard of care in many centres and it is commonly associated with the need for cardiopulmonary bypass. Conventional external aortic clamping (exoclamping) is not always feasible, so endoaortic clamping (endoclamping) has evolved as a viable alternative. The aim of this study is to compare endoclamping (Intraclude™, Edwards Lifesciences) with exoclamping (Chitwood) during minimally invasive mitral valve procedures. Methods This single-centre study included 822 consecutive patients undergoing minimally invasive mitral valve procedures. The endoclamp was used in 64 patients and the exoclamp in 758. Propensity-score (PS) matching was performed resulting in 63 patients per group. Outcome measures included procedural variables, length of intensive care unit (ICU) and hospital stay, major adverse cardiac and cerebrovascular events (MACCE) and repeat surgery. Results The mean age was similar in the two group (62.2 [endoclamp] vs. 63.5 [exoclamp] years; p = 0.554), as were the cardiopulmonary bypass (145 vs. 156 min; p = 0.707) and the procedure time (203 vs. 211 min; p = 0.648). The X-clamp time was significantly shorter in the endoclamp group (88 vs. 99 min; p = 0.042). Length of ICU stay (25.0 vs. 23.0 h) and length of hospital stay (10.0 vs. 9.0 days) were slightly longer in the endoclamp group, but without statistical significance. There were nominal but no statistically significant differences between the groups in the rates of stroke, vascular complications, myocardial infarction or repeat mitral valve surgery. The conversion rate to open sternotomy approach was 2.4% without difference between groups. The estimated 7-year survival rate was similar for both groups (89.9% [endoclamp]; 84.0% [exoclamp]) with a hazard ratio of 1.291 (95% CI 0.453–3.680). Conclusions Endoaortic clamping is an appropriate and reasonably safe alternative to the conventional Chitwood exoclamp for patients in which the exoclamp cannot be used because the ascending aorta cannot be safely mobilised.

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