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DOUBLE VERSUS SINGLE DOUBLE STAGE VENOUS CANNULA IN MINIMALLY INVASIVE MITRAL VALVE REPAIR.
Alberto Repossini, MD, Lorenzo Di Bacco, MD, Laura Giroletti, MD, Fabrizio Rosati, MD, Gianluigi Bisleri, MD, Claudio Muneretto, MD.
University of Brescia Medical School, Brescia, Italy.

OBJECTIVE: We investigate outcomes of patients that underwent minimally invasive mitral valve repair through antero-lateral right thoracotomy, by venous drainage via single femoral double stage cannula versus venous drainage via femoral vein plus percutaneous right jugular vein.
METHODS: From 2012 to 2015, two hundred-ninenty patients underwent minimally invasive mitral valve repair at our institution. Venous drainage was assured by percutaneous right jugular vein and right femoral vein cannule in the first group (167 patients, G1) and by single femoral vein cannula in the second group (123 patients, G2). We analyzed how the efficacy of cardiopulmonary by-pass and the early post-operative outcomes were influenced by the different type of venous drainage.
RESULTS: After propensity matching, 2 cohorts of 93 patients were obtained. Every patients received antegrade HTK cold solution (Custodiol) for myocardial protection. Conversion to median sternotomy was reported in 2 cases in G1 (2,15%) and 1 case in G2 (1,07%) due to bad exposure, p=0,574. Some differences among the two groups were reported in Cardiopulmonary By-Pass (CPB) management: CPB time was significantly longer in G1 (G1:154±16.2 min vs G2:122±10.1, p<0.001) but Aortic Cross-Clamp time was similar (G1:115±17.8 min vs G2:104±6.8, p=0.121). Blood flow during CPB was similar among two groups and adequate to the body surface area for each patient (G1:4.1±0.55 l/min vs G2:4.2±0.6 l/min, p=0.693) as well as mean Arterial Pressure(G1:74.8±5.2mmHg vs G2:75.3±5.1mmHg, p=0.818). Acid-Base equilibrium was monitored through emogas analysis during CPB: pH(G1:7.41±0.45 vs G2:7.41±0.32, p=0.951), Base Excess(G1:2.3±0.45 vs G2:1.9±0.32, p=0.671), blood lactate(G1:1.05±0.25 vs G2:0.89±0.25, p=0.851) and Bicarbontes(G1:27.1±2.41 vs G2:26.2±1.6, p=0.428) concentration were similar among groups. No death within 30 days from surgery was reported among the two groups. Only one in G1 early reoperation for repair failure. During post-operative period no major epatic injuries was reported, only 3 temporary bilirubine values rising (G1:1.07% vs G2:2.15%, p=0.574), mean bilirubine values were similar among groups(G1:1.15±2.41 vs G2:26.2±1.6, p=0.428). Mean day 1 post-operative CK-MB was not signifantly but higher in G2(G1:30.9±3.2 vs G2: 35.2±4.6, p=0.378).
CONCLUSIONS: Both strategies guarantee optimal venous drainage during minimally invasive mitral valve repair with surgical visualization with excellent results and low grade of post-operative complications.


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