Cannulation Strategy Using Axillary Versus Femoral Artery For Minimally Invasive Cardiac Surgery
Yoshitsugu Nakamura, Shuhei Nishijima, Miho Kuroda, Takaki Hori, Taishuke Nakayama, Yujiro Ito.
Chibanishi general hospital, Chiba, Japan.
BACKGROUND: In patients with vascular comorbidities, minimally invasive cardiac surgery (MICS) using retrograde perfusion via femoral cannulation (FC) carries higher risk of brain embolization compared with antegrade perfusion. Axillary cannulation (AC) is the one of the straightforward options to establish antegrade perfusion. However, it is unclear which patient to select FC or AC. The aim of this study is to assess the feasibility of our selection criteria of FC versus AC in MICS based on preoperative enhanced computed tomography (CT) to prevent brain embolization.METHODS: Between July 2015 and July 2018, 273 MICS patients underwent preoperative CT. Mean age was 68 +/- 14. 152 patients were male. Mean BSA was 1.55 +/- 0.2 m2. Significant aortoiliac lesions were defined by thickness (greater than 3 mm for both atheroma and calcification) and circumferentiality (more than one third for atheroma and/or total circumferential for calcification). AC was selected when the CT showed the significant aortoiliac lesions. The procedures performed were 133 aortic valve replacement (44.9%), 141 mitral valve repair/replacement (52.0%), and others (3.1%). Brain diffusion-weighted magnetic resonance image (MRI) were taken postoperatively at day 5 in all patients to detect silent brain injury (ABI) in addition to symptomatic brain embolization.RESULTS: AC was selected 93 patients (34.1%) while FC was selected in remaining 180 patients (65.9%). There was no patient who required additional cannulation, however 1 patient in AC group and 5 patients in FC group required side-branch reconstruction for cannulation to small arteries Mean cannula size was 16.6 +/- 1.1 French. The median cross clamp and cardiopulmonary time were 108 +/- 36 and 139 +/- +8 minutes, respectively. There was no mortality. Two (0.7%) patients had symptomatic cerebral infarction (1 in AC group, and 1 in FC group which occurred postoperative day 3 due to atrial fibrillation), and 52 (19.0%) patients had SBI (25 in group and 27 in FC group) on postoperative MRI.CONCLUSIONS: Postoperative brain embolization rate was extremely low. Our cannulation strategy to select FC or AC based on preoperative CT was effective to prevent brain embolization.
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