Risk Factors Of Limb Ischemia In Minimally Invasive Cardiac Surgery
Takayuki Kawashima, Shinji Miyamoto, Hirofumi Anai, Tomoyuki Wada, Takashi Shuto, Aiko Kodera, Keitaro Okamoto, Madoka Kawano, Tadashi Umeno, Takafumi Abe.
Oita University, Oita, Japan.
OBJECTIVE: In minimally invasive cardiac surgery (MICS), the common femoral artery (CFA) cannulation during cardiopulmonary bypass (CPB) could cause limb ischemia (LI). To date cannula-artery discrepancy is mainly picked up for discussion to avoid LI. We hypotheses that lack or poor collateral circulation via the deep femoral artery (DFA) may be more significant than the size discrepancy in terms of LI. This study evaluates the risk factors of LI in MICS from the point of view of anatomy of the femoral arteries.
METHODS: We performed a retrospective review of 48 patients underwent MICS without prosthetic graft conduit for femoral arterial cannulation between February 2013 and December 2016 at our institution. We used maximum value of postoperative creatine kinase (CKmax) as the index of postoperative LI. To exclude the influence of each muscle mass, CK divided the area of muscles of femoral regions and it is defined as CK/MA. The predictor for LI, including age, sex, body mass index (BMI), CPB time, the diameter of CFA, surperficial femoral artery (SFA) and DFA, remaining lumen size of CFA after the cannulation were analyzed.
RESULTS: Critical limb ischemia occurred in one of 48 (2%) patients. This patient’s labo data showed very high CK (CKmax 87910IU/L, CK/MA 563.5 IU/L/cm2) and his DFA was much smaller than SFA (SFA 9.3mm, DFA 6.8mm). In this cohort, the median CKmax was 2154 U/L (1404-3157) and the median CK/MA was 17.4 U/L/cm2 (11.4-21.8). In multivariate analysis of CK/MA > 20, DFA<SFA was only independent predictor (Odds ratio 4.035, 95% CI 1.058- 15.395, p= 0.041) and remaining lumen size of CFA was not risk factor.
CONCLUSIONS: Our result suggested DFA<SFA was risk factor for LI in MICS. In DFA<SFA cases, attention should be paid to choice of the cannulation site.
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