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Prevention of lower limb ischemia with near-infrared spectroscopy monitoring in minithoracotomy cardiac surgery under femoral artery cannulation
Kazuma Okamoto, Noriyuki Hirabyashi, Mikihiko Kudo, Akihiro Yoshitake, Yuta Akamatsu, Hidetoshi Oka, Takayuki Kawashima, Mio Kasai, Akinori Hirano, Hiroto Kitahara, Shinji Kawaguchi, Ichiro Kashima, Ryo Aeba, Hideyuki Shimizu.
Keio University, Tokyo, Japan.
OBJECTIVE: Efficacy of near-infrared spectroscopy monitoring for prevention of lower limb ischemia in minithoracotomy cardiac surgery under femoral artery cannulation was verified.
METHODS: Near-infrared spectroscopy monitoring using INVOS Cerebral/Somatic Oximeter (Medtronic) was applied to monitor regional oxygen saturation (rSO2) of blood in the lower legs in 62 cases in minithoracotmy cardiac surgery (mitral valve repair (36), mitral valve replacement (6), atrial septal defect closure (17), and tumor (3) with/without tricuspid valve repair) with femoral artery cannulation.
RESULTS: In 22 cases, depression of rSO2 greater than 30% from the baseline was observed. In 9 cases, distal perfusion of cannulated femoral artery was added in reference to the rSO2 depression. An apparent compartment syndrome of the lower leg was occurred in a case without distal perfusion despite depression of rSO2. In comparison between two groups (A: rSO2 depression, B: without depression), body hight (1.69 m vs 1.64 m, P=0.027), total perfusion time (225.6 min vs 166.0 min, P=0.031), and aortic cross clamping time (154.2 min vs 107.3 min, P=0.036) were significantly longer in group A.
CONCLUSIONS: Monitoring of rSO2 and distal perfusion in case with rSO2 depression was an efficient prevention of lower limb ischemia during minthoracotomy cardiac surgery using femoral artery cannulation. 
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