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Peripheral Cannulation for Minimally Invasive Cardiac Surgery: Specific Preoperaory Assessment is Really Necessary? Over 700 Procedures Experience.
Tommaso Hinna Danesi, Giovanni Domenico Cresce, Alessandro Favaro, Loris Salvador.
Ospedale San Bortolo Vicenza, Vicenza, Italy.

OBJECTIVE: Several cannulation techniques for minimally invasive cardiac surgery (MICS) procedure are available and seems to be determinants of technical difficulty and clinical outcomes. Reducing operating field shifted central cannulation to peripheral approach. A specific preoperative assessment, including an iliac and femoral axis CT scan it’s often performed.
METHODS: At our Institution from Jan 2010 to May 2014, 713 on-pump MICS procedures were performed through a mini-right thoracotmoy in a complete videoguided fashion. Method of arterial and venous cannulation and aortic cross clamp was the same for every patients. No preoperative additional examination were performed, including no additional femoral CT scan. Outcomes of interest included in-hospital stroke, myocardial infarction, and 30 day mortality and morbility.
RESULTS: Mean age of study population was 61.8 ± 7.7 years, 66.4% with male. The MICS procedures included mitral, aortic and tricuspid valves surgery, atrial septal defects repair, AFib ablation and cardiac tumors resections. A single or bilateral femoral artery was used for all arterial perfusion; venous drainage was achieved with percutaneous femoral cannulation single or dual-stage or in case of complex tricuspid valve repair surgery with additional neck access. Aortic occlusion was achieved in 672 with extrernal clamp and in specific redo patient was achieved by endoaotic balloon (0.8%). Every patient received antegrade crystalloid plegia. Surgery in low EF patient was performed under beating or fibrillating heart (4.9%). Mean CPB time and aortic x-clamp time were respectively 133 ± 16.2 min and 85 ± 7 min. Overall, there were four major strokes (0.05%), four transient neurological syndromes (0.05%); incidence of myocardial infarction and deaths within 30 day of surgery were respectively 1.1% and 2.5%.
CONCLUSIONS: In a completely thoracoscopic approach with a small thorax port peripheral cannulation offers several advantage in operating field space management. In our experience, this approach has resulted in low ratio of neurological and myocardial events. Widespread additional preoperative radiological assessments are not necessary.

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