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Lamelas J, Williams RF, Mawad M, LaPietra A. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery. Ann Thorac Surg 2017; 103:1927-1932. [DOI: 10.1016/j.athoracsur.2016.09.098] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 08/29/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
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Bainbridge DT, Chu MWA, Kiaii B, Cleland A, Murkin J. Percutaneous superior vena cava drainage during minimally invasive mitral valve surgery: a randomized, crossover study. J Cardiothorac Vasc Anesth 2014; 29:101-6. [PMID: 25440652 DOI: 10.1053/j.jvca.2014.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Minimally invasive techniques commonly are applied to mitral valve surgery; however, there has been little research investigating the optimal methods of cardiopulmonary bypass for the right minithoracotomy approach. Controversy exists as to whether a percutaneous superior vena cava drainage cannula (PSVC) is necessary during these operations. The authors, therefore, sought to determine the effect of using a percutaneous superior vena cava catheter on brain near-infrared spectroscopy, blood lactate levels, hemodynamics and surgical parameters. DESIGN Randomized, blinded, crossover trial. SETTING Tertiary care university hospital. PARTICIPANTS Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy. INTERVENTIONS Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage, during mitral valve repair. MEASUREMENT AND MAIN RESULTS For the primary outcome of brain near-infrared spectroscopy, there were no differences between the two groups (percutaneous superior vena cava clamped 55.0%±11.6% versus unclamped 56.1%±10.2%) (p = 0.283). For the secondary outcomes pH (clamped 7.35±0.05 versus unclamped 7.37±0.05 p = 0.015), surgical score (clamped 1.96±1.14 versus unclamped 1.22±0.51 p = 0.002) and CVP (clamped 11.6 mmHg±4.8 mmHg versus unclamped 6.1 mmHg±6.1 mmHg p<0.001) were significantly different. CONCLUSIONS The use of a percutaneous superior vena cava drainage improved surgical visualization and lowered CVP, but had no effect on brain near infrared spectroscopy during minimally invasive mitral valve surgery. (ClinicalTrials.gov Identifier: NCT01166841).
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Affiliation(s)
- Daniel T Bainbridge
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario Canada.
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London, Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London, Ontario Canada
| | - Andrew Cleland
- Department of Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - John Murkin
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario Canada
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Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP, Phan K, Misfeld M, Mohr F, Yan TD. Systematic review of robotic minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2014; 2:704-16. [PMID: 24349971 DOI: 10.3978/j.issn.2225-319x.2013.10.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/31/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Robotic telemanipulators have evolved to assist the challenges of minimally invasive mitral valve surgery (MVS). A systematic review was performed to provide a synopsis of the literature, focusing on clinical outcomes and cost-effectiveness. METHOD Structured searches of MEDLINE, Embase, and Cochrane databases were performed in August 2013. All original studies except case-reports were included in qualitative review. Studies with ≥50 patients were presented quantitatively. RESULTS After applying inclusion and exclusion criteria to the search results, 27 studies were included in qualitative review, 16 of which had ≥50 patients. All studies were observational in nature, and thus the quality of evidence was rated low to medium. Patients generally had good left ventricular performance, were relatively asymptomatic, and mean patient age ranged from 52.6-58.4 years. Rates of intraoperative outcomes ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106±22 to 188.5±53.8 min for cardiopulmonary bypass (CPB) time and 79±16 to 140±40 min for cross-clamp (XC) time. Rates of short-term postoperative outcomes ranged from: 0.0-3.0% for mortality, 0.0-3.2% for myocardial infarction (MI), 0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3±6.7 to 36.6±24.7 hours for intensive care length of stay, 3.1±0.3 to 6.3±3.9 days for hospital length of stay (HLOS) and 81.7-97.6% had no or trivial mitral regurgitation (MR) before discharge. CONCLUSIONS All subtypes of mitral valve prolapse are repairable with robotic techniques. CPB and XC times are long, and novel techniques such as the Cor-Knot, Nitinol clips or running sutures may reduce the time required. The overall rates of early postoperative mortality and morbidity are low. Improvements in postoperative quality of life (QoL) and expeditious return to work offset the increase in equipment and intraoperative cost. Evidence for long-term outcomes is as yet limited.
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; ; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
| | - Christopher Cao
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Paul G Bannon
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; ; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Michael P Vallely
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; ; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich Mohr
- Department of Cardiac Surgery, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Lei Q, Zeng QS, Zhang XS, Xie B, Luo ZC, Guo HM, Chen JM, Zhuang J. Superior vena cava drainage during thoracoscopic cardiac surgery: bilateral internal jugular vein sheaths versus one percutaneous superior vena cava cannula. J Cardiothorac Vasc Anesth 2013; 28:914-8. [PMID: 24139456 DOI: 10.1053/j.jvca.2013.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate bilateral internal jugular vein sheaths as a replacement of one percutaneous superior vena cava cannula for superior vena cava drainage during thoracoscopic cardiac surgery. DESIGN A prospective and randomized study. SETTING Single cardiovascular institute. PARTICIPANTS Adults undergoing thoracoscopic cardiac surgery. INTERVENTIONS Patients were randomized into a percutaneous superior vena cava cannula group and a bilateral internal jugular vein sheaths group. The superior vena cava drainage for cardiopulmonary bypass was performed with one percutaneous superior vena cava cannula (14-18 Fr) or the bilateral internal jugular vein sheaths (8 Fr). MEASUREMENTS AND MAIN RESULTS Both interventions reached theoretic flow rate in all patients. In patients weighing<50 kg (n=38) and 50-70 kg (n=64), the average central venous pressure values during cardiopulmonary bypass of both groups showed no significant differences. The patients weighing>70 kg (n=15) in the bilateral internal jugular vein sheaths group had a normal average central venous pressure value, but it was significantly higher than that of percutaneous superior vena cava cannula group ([10.5±3.1] mmHg vs. [4.5±4.4] mmHg, p=0.013). The patient satisfaction scale scores for the cervical incisions were significantly higher in the bilateral internal jugular vein sheaths group than in the percutaneous superior vena cava cannula group ([2.6±0.9] vs. [2.1±0.8], p=0.002). CONCLUSIONS The bilateral internal jugular vein sheaths were a feasible and effective option to replace one percutaneous superior vena cava cannula during thoracoscopic cardiac surgery, with better patient satisfaction.
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Affiliation(s)
- Qian Lei
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing-Shi Zeng
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Shen Zhang
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Xie
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Chao Luo
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui-Ming Guo
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Ji-Mei Chen
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
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Dandolu BR, Parmet JL, Yarnall C, Isidro A, Bridges CR. Minimally Invasive Cardiac Surgery Using a Flexible Aortic Clamp. Heart Surg Forum 2007; 10:E428-30; discusson E430. [DOI: 10.1532/hsf98.20071080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Colangelo N, Torracca L, Lapenna E, Moriggia S, Crescenzi G, Alfieri O. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion 2007; 21:361-5. [PMID: 17312860 DOI: 10.1177/0267659106071324] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The diffusion of minimally invasive cardiac surgery (MICS) during open-heart surgery has increased the use of assisted venous drainage support for cardiopulmonary bypass (CPB). Peripheral cannulation with small cannulae and vacuum-assisted venous drainage (VAVD) during MICS has been adopted in our institution since 1998. After the Heartport technique (HP) experience, the trans-thoracic clamp technique is now currently used. The aim of this study is to report our experience with extrathoracic CPB with VAVD application (on CPB) during open-heart MICS. From October 1999 to June 2006, 193 patients underwent MICS. Thirty-seven (19.2%) patients were treated with the HP - 13 (35%) with robotic technology and 156 (80.8%) with trans-thoracic aortic clamping (TTAC). Mean age was 39 years (range: 12-77), and 114 patients (59.1%) were female. A total of 128 patients (66.3%) underwent mitral valve surgery, 57 (29.6%) atrial septal defect closure, five (2.6%) cardiac mass removal, and three (1.5%) tricuspid valve repair. Four patients (2.0%) had a previous cardiac procedure. Peripheral CPB was established with a standard coated circuit. A 14 Fr arterial cannula was inserted into the right jugular vein and positioned at the atrial/superior vena cava junction. A 21 or 28 percutaneous femoral cannula, depending on body surface area, was inserted in the femoral vein and an arterial cannula in the right femoral artery. Gravitational drainage was combined with VAVD. To improve the safety and effectiveness of this technique, we monitored the pressure on each venous cannula and in the reservoir. The mean CPB time was 74.8∓30 min (TTAC) and 119∓48 min (HP); mean aortic clamping time was 51∓19 min (TTAC) and 73∓29 min (HP). We did not record any neurological complication. Two patients (1.0%), one from each group, were converted to sternotomy. Three patients (1.5%) underwent re-exploration for bleeding. In-hospital mortality was 0.5% (N = 1) (HP). Mechanical ventilation time and intensive care unit stay were comparable to those recorded with conventional sternotomy. In conclusion, we found that extrathoracic CPB and VAVD during trans-thoracic clamping is a safe, simple, and effective technique for MICS. However, there is a potential risk of haemolysis and air embolism, which can be prevented with vacuum monitoring, and with the addition of gravitational drainage to reduce vacuum pressure.
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Affiliation(s)
- Nicola Colangelo
- Department of Cardiac Surgery and Cardiovascular Perfusion, San Raffaele University Hospital, Milan, Italy.
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Field ML, Al-Alao B, Mediratta N, Sosnowski A. Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes. Postgrad Med J 2006; 82:323-31. [PMID: 16679471 PMCID: PMC2563780 DOI: 10.1136/pgmj.2005.037929] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 09/19/2005] [Indexed: 11/04/2022]
Abstract
Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes: (a) repeat surgery, (b) minimally invasive surgery, and (c) cases with diseased vessels such as porcelain, aneurysmal, and dissecting aorta. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the development of closed chest extracorporeal life support, in the form of cardiopulmonary support and extracorporeal membrane oxygenation. With this development have come applications for cardiopulmonary bypass based support outside the traditional cardiac theatre setting, including emergency circulatory support for patients in cardiogenic shock and respiratory support for patients with severely impaired gas exchange. This review summarises the approach to extrathoracic cannulation for the generalist.
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Affiliation(s)
- M L Field
- Cardiothoracic Centre, Liverpool L14 3PE, UK.
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