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Percutaneous SuperiorVena Cava Drainage Improves Outcomes During Minimally Invasive Mitral Valve Surgery: A Randomized, Cross-Over Study
Michael W. Chu, Bob Kiaii, Andrew Cleland, John Murkin, Daniel T. Bainbridge.
University of Western Ontario, London, ON, Canada.

OBJECTIVE: Minimally invasive mitral valve surgery relies upon optimal venous drainage and perfusion strategies to prevent cardiac distension and allow adequate perfusion. Controversy exists as to whether a percutaneous superior vena cava drainage cannulae (PSVC) is necessary during these operations. We therefore sought to determine the effect of using a PSVC on brain near infrared spectroscopy (BNIRS), blood lactate levels, as well as hemodynamic and surgical parameters.
METHODS: Using a randomized cross over study design, patients undergoing minimally invasive mitral valve surgery were allocated to 20 minutes of PSVC line unclamped and 20 minutes of PSVC line clamped during minimally invasive mitral valve repair. Both perfusion and surgery were blinded to the intervention. Inclusion criteria included any patients between the age of 18 and 80, undergoing elective mitral valve surgery through right mini thoracotomy with at least 40 minutes of cardiopulmonary bypass time.
RESULTS: Of the 40 patients approached to participate in the trial, a total of 35 underwent randomization. Mean patient age was 67±14 and 36% were female. Mitral valve repair and replacement were performed in 77% and 23% of patients, respectively. Concomitant procedures were performed in 25.6% of patients and included mostly Cryomaze and tricuspid valve repair. Comprehensive outcomes data are shown in Table 1. For the primary outcome of BNIRs there were no differences between the two groups (PSVC clamped 55.0 ± 11.6 versus control 56.1 ± 10.2; p= 0.283). The secondary outcomes were similar except for pH, surgical score and CVP, which were statistically significantly different, all favoring the use of the PSVC line (unclamped). No patients experienced any complications as a result of PSVC line clamping.
CONCLUSIONS: The use of the PSVC cannula improves venous drainage and surgical visualization during minimally invasive mitral valve surgery. BNIRs do not appear to be affected over the short 20 minutes trial period of the study; however, without a PSVC line, the effects on brain perfusion are unknown at longer durations.



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