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Evaluation Of Peripheral Arterial Cannulation Techniques In Minimally Invasive Valve Surgery
Juan S. Jaramillo, Bob Kiaii, Daniel Bainbridge, Ivan Iglesias, Michael Chu.
London Health Science Centre, London, ON, Canada.

OBJECTIVE: Minimally invasive valve surgery can be achieved through a minithoracotomy but has known risks and limitations of peripheral cannulation including retrograde perfusion, aortic dissection and leg ischemia. Regional oxygen saturation measured by means of near-infrared spectroscopy (NIRS) may be a useful noninvasive tool to continuously monitor and detect lower limb ischemia. We sought to evaluate the differences between direct femoral arterial cannulation or an 8-mm Dacron graft in minimally invasive valve surgery.
METHODS: We evaluated 26 patients who underwent peripheral cardiopulmonary bypass (CPB) by direct femoral arterial cannulation (n=11) or 8-mm Dacron graft (n=15) for minimally invasive valve or ASD surgery between May 2011 and December 2012. A 4-cm right minithoracotomy was employed in all cases. Operations performed included mitral valve repair/replacement (22 cases), aortic valve replacement (1 case), ASD + tricuspid repair (3 cases).
RESULTS: Patient demographics were similar between the two groups. Overall, there was only one mortality which occurred in the cannula group. In the cannulae and graft groups, no patients experienced perioperative stroke or aortic dissection, respectively. The median NIRS value in the cannula group during the cross clamp time was 58,45+/-10,57 and in the graft group was 71,60+/-12,19 (p value = 0.008). The mean CPB and cross clamp times were 176,36+/-53,11 and 117,89+/-33,43 in the cannulae group and 209,87+/-72,48 and 130,92+/-48,41 in the graft group (p= 0,207 and 0,498), respectively. There were no differences in complications between the two groups. Median ICU and hospital lengths of stay were 1 and 5 in the cannulae group, and 1 and 7 days in the graft group (p= 0,402 and p=0.088).
CONCLUSIONS: Peripheral cannulation with an 8-mm Dacron side graft appears to have improved lower limb perfusion compared to cannulation alone for minimally invasive valve surgery. Continuous lower limb NIRS monitoring provides excellent realtime assessment for lower limb perfusion and should be considered in all cases requiring peripheral cannulation. Further investigation with a randomized trial is warranted.


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