Peripheral Cannulation In Minimally Invasive And Robotic Cardiac Surgery: Is The Patient At Risk
Paola K. Montanhesi, Alisson P. Toschi, Renato B. Pope, Sergio A. Curcio, Robinson Poffo.
Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Background: Retrograde perfusion is associated with a higher risk of stroke and complications from arterial femoral cannulation, as aortic dissection, distal limb ischemia, wound seroma, lymphoid fistula, and wound infection. Preoperative vascular imaging may predict difficulties with femoral cannulation and perfusion, resulting in better preoperative planning and adequate prevention of vascular complications and cerebral embolization, especially in patients with subclinical aortoiliac disease. The objective of this study is to assess the incidence of complications related to perfusion strategies in minimally invasive cardiac procedures. Methods: Prospective study included 97 consecutive patients submitted to minimally invasive cardiac surgery from March 2010 to December 2017. All patients underwent preoperative computed tomography angiography of the aorto-ileo-femoral system. A femoral luminal diameter of 5,0 mm or less, the presence of tortuosity, and extensive calcification or signs of dissection were considered as absolute contraindications for peripheral cannulation. Results: Upper partial sternotomy (30,9%), video-assisted (21,6%) and robotic procedures (47,4%) were performed. Fifty-five patients (56,7%) were male; mean age was 52,9 ± 18,9 years; mean body surface area was 1,85 ± 0,24 m2. Comorbidities were hypertension (43%), smoking (16%), and dyslipidemia (11%). Cannulation of the femoral artery was performed in 75,2% of patients with no complications. Venous cannulation was peripheral in all cases. There was one conversion to full sternotomy due to right ventricle perforation. Mean cardiopulmonary bypass time and mean aortic cross-clamp time were respectively 180,02 ± 59,19 and 128,91 ± 48,59 minutes. Most common complication was arrhythmia (16%). No stroke or wound infection were observed. There were no complications regarding femoral vessels cannulation. The median intensive care unit (ICU) stay was 1 day and total hospital stay, 4 days. 30-day mortality was 1,03% (N=1). Short-term outcomes were satisfactory in all 96 cases, with no complications within 30 days. Conclusions: Peripheral cannulation with retrograde perfusion was found to be feasible, safe and effective in selected patients. Preoperative evaluation of anatomical or pathological abnormalities of the peripheral vascular system with computed tomography angiography is mandatory, specially in older patients. Longer follow-up and a larger cohort may support our initial results.
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