Is Peripheral Cannulation Required For Minimally Invasive Cardiac Surgery. A Single Center Experience
SURESH BABU KALE1, Punithakumar Ramasamy2, GUNDILAPALLI NARASIMHAIAH CHENNAKESHAVALLU1.
1MEENAKSHI HOSPITAL, THANJAVUR, India, 2MEENAKSHI HOSPITAL, Thanjavur, India.
Background Direct central cannulation of the aorta and the venacava to establish total cardiopulmonary bypass was used without any peripheral cannulation as a common platform for correction of a wide range of cardiac defects through various approaches and without any complications. Methods From October 2015 to November 2019, 276 patients underwent minimally invasive cardiac surgery with central cannulation through various approaches [Table 1]. No special imaging was required in any of these cases. The weight ranged from 11 kilograms to 80 kilograms. There were 191 cases within 12 years of age, 59 cases between 12-18 years of age and 26 cases aged more than 18 years. Routine aortic and right angled metal tip venous cannulae were used to establish cardiopulmonary bypass (CPB). Results No patient required peripheral cannulation. Three patients were converted to median sternotomy from right anterior mini thoracotomy for failure of central cannulation. Three patients died due to low cardiac output syndrome and three patients were re-explored, two for residual defects and one for bleeding. No neurological, renal or myocardial events were reported during the study period. Conclusions Central cannulation of ascending aorta and venacava is feasible, safe and reproducible through various minimally invasive approaches. The technique does not require special cannulae or instruments or change in perfusion strategy. It can be learnt quickly and avoids the complications of peripheral cannulation. Legend to Table 1: ASD: atrial septal defect VSD: ventricular septal defect ICR: intracardiac repair PAVSD: partial atrioventricular septal defect MVR: mitral valve replacement AVR: aortic valve replacement LA: left atrium CPB: cardiopulmonary bypass AoCC: aortic cross clamp time BSA: body surface area
| Procedure | CPB | AoCC | BSA | Weight | Number of cases |
| ASD | 61.40 ± 16.09 | 31.64 ± 10.57 | 0.96 ± 0.29 | 25.37 ± 11.44 | 180 |
| VSD | 83.73 ± 26.69 | 51.64 ± 18.81 | 0.89 ± 0.30 | 22.28 ± 9.34 | 66 |
| ICR | 135.14±50.88 | 94.85 ± 42.89 | 0.93 ± 0.24 | 24.14 ± 10.58 | 12 |
| PAVSD | 84 ± 16.97 | 52.5 ± 4.94 | 0.98 ± 0.40 | 28.5 ± 13.43 | 6 |
| MVR | 105.25 ± 22.40 | 61.75 ± 11.00 | 1.50 ± 0.25 | 51.25 ± 12.95 | 6 |
| AVR | 95.00 ± 12.68 | 62.50 ± 4.12 | 1.60 ± 0.16 | 60.25 ± 12.20 | 5 |
| LA Myxoma | 110 | 70 | 1.65 | 76 | 1 |
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