Safety and Efficacy of Routinary Retrograde Arterial Flow Via Femoral Artery During Minimally Invasive Cardiac Surgery
Claudio Muneretto, Laura Giroletti, Alberto Repossini, Gianluigi Bisleri.
University of Brescia Medical School, Brescia, Italy.
OBJECTIVE: Minimally invasive procedures have been gaining popularity during recent years and often imply the use of peripheral sites for CPB cannulation. Nevertheless, there is lack of evidence whether retrograde arterial flow following femoral artery cannulation in elective surgery could lead to an increased risk for iatrogenic complications, such as thromboembolisms and retrograde aortic dissection.
METHODS: From March 2000 to October 2013, 496 consecutive patients underwent minimally invasive cardiac surgical procedures by means of femoral artery cannulation with a seldinger approach and arterial retrograde CPB flow with a centrifugal pump. Mean age was 58.8±13.9 yrs while Logistic Euroscore was 4.1±1.9. Average values of BMI and BSA were 26 ± 5,56 Kg/m2 and 1,81±0.22 m2 respectively. Peripheral vascular disease (not critical) was present in 29,4% (146/354 pts). Patients undergoing surgical treatment of aortic dissection and aortic arch procedures were excluded from the data analysis.
RESULTS: Mitral valve surgery was performed in 190 pts.(38,3%), while surgery of the aortic valve/ascending aorta in 229 pts.(46,2%); 11,7%(58 pts) of cases underwent surgical closure of ASD/PFO. Finally, other procedures(including myxoma removal) were performed in 3,8% of cases (19 pts). Iatrogenic aortic dissection did not occur in any patient of the current series. Minor strokes or TIAs occured in 6 patients( 1,2%), all of them showing full functioning recovery at 30 days postoperatively. Limb complications, such as ischemia or femoral vessel dissection was 0%, while femoral nerve injuries(local paresthesia) were recorded in 1.8%(9/496 pts); inguinal lymphorrea occurred in 2 pts(0.4%). Hospital mortality was 0.8% (4 pts).
CONCLUSIONS: Arterial retrograde perfusion with Seldinger cannulation of the femoral artery and centrifugal pump during minimally invasive cardiac surgery is nowadays a safe manoeuvre and is not associated with an increased risk of iatrogenic aortic dissection or major thromboembolic complications. The routine peripheral arterial cannulation enhances the feasibility of minimally invasive procedures while reducing the drawbacks of central cannulation through limited access.
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