Monitoring Of Lower Leg Regional Oxygen Saturation During Groin Cannulation In Minimally Invasive Cardiac Surgery
Kazuma Okamoto1, Yasunari Shibata2, Hiroya Kano2, Shuta Oshiro2, Takeshi Morishima2, Ryo Touma1, Shinichi Ijuin1, Takuya Misato1, Taro Hayashi1, Masahiro Yamaguchi1, Satoshi Tobe1.
1Cardiovascular Surgery, Akashi Medical Center, Akashi, Japan, 2Clinical engineering department, Akashi medical center, Akashi, Japan.
OBJECTIVE: In minimally invasive cardiac surgery (MICS) via right minithoracotomy, retrograde perfusion with femoral artery cannulation is a fundamental technique to provide an optimal working space under a small thoracotomy. Lower leg ischemia is a serious complication in femoral artery cannulation. In order to clarify the severity of lower leg ischemia in MICS and to propose an effective prevention the complication, the result of regional oxygen saturation (rSO2) monitoring by near-infrared spectroscopy (NIRS) in MICS was analyzed.
METHODS: In 21 MICS cases with femoral artery cannulation (mitral valve repair 20 myxoma resection 1), NIRS monitoring by an INVOS Cerebral/Somatic Oximeter (Medtronic) was applied to monitor rSO2 of blood. The right femoral artery was cannulated using the Seldinger technique without any taping or clamping of the femoral artery. Arterial cannula size was decided with demanded pump flow based on body mass index. When rSO2 happens, distal perfusion using five Fr sheath was added or cannula position was moved slightly.
RESULTS: Although depression of rSO2 greater than 30% from the baseline (48.7±13.7% (31.8% - 74.1%)) was observed in nine cases (42.9%), no apparent compartment syndrome of the lower leg was observed. Distal perfusion was added in two case and cannula position was changed in two cases. In comparison between two groups (A: rSO2 depression, B: without depression), statistically significant difference was not found in base character including body size, sex and cannula size for the femoral artery. There was no difference in postoperative blood creatine kinase and blood lactate level between two groups.
CONCLUSIONS: Lower leg ischemia was prevented owing to NIRS monitoring of the lower leg and appropriate reaction in MICS with feral artery cannulation. Because significant rSO2 depression occurs in high rate (42,.9%), NIRS monitoring is indispensable in MICS. Current study did not clarify predictive factor toward rSO2 depression.
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