Femoral Venous Cannulation for Minimally Invasive Surgery: Three Years Experience with Wall-less, Self-expandable Cannula
Carlo Savini, Gregorio Gliozzi, Sofia Martin-Suarez, Zardin Davide, Carlo Mariani, Giulio Giovanni Cavalli, Gianluca Folesani, Davide Pacini
Policlinico di Sant'Orsola, Bologna, Italy
BACKGROUND: The target of an optimal minimally invasive setting is to minimize surgical trauma: trans-femoral venous cannulation with virtually wall-less,self-expandable offers an excellent drainage and surgical exposure.In this study, almost three years of prospective experience with this device are reported: intraoperative performance of the wall-less cannula was compared to a standard drainage settings with dual-stage cannula
METHODS: From January 2018 to October 2020, were prospectively enrolled seventy patients underwent minimally invasive surgery for mitral disease.Trans-femoral venous cannulation with wall-less cannula (3/8″ 24Fr 630-730mm)was used in 54 randomized patients (Group 1), while standard dual stage venous cannulas (3/8Ē 23Fr distal/25FR proximal, 72.5mm) was used in 54 other patients (Group 2). Our approach provide for femoral vessels surgical cutdown and cannulation with Seldinger technique.The venous cannulas were then fed over the wire and adequately positioned under echocardiographic control. As marker of quality of cardiopulmonary bypass, five intraoperative hemogasanalysis sample, preoperative and postoperative blood tests (in first, third and fifth postoperative days) were collected and compared between two groups.
RESULTS: Mean target flows were 3.74+0.36L/min and 3.47+0.40L/min for Group 1 and Group 2 respectively (p=0.009). Mean achieved flows were 4.70+0.51L/min and 4.39+0.52L/min (p=0.017), corresponding to 126% and 127% of the target respectively. Rate of vacuum assist, in case of poor drainage was only 17.1% in Group 1, versus 63% in Group 2 (logistic regression p<0.000 OR=0.066 [IC 0.019;0.224]). Intraoperative hemogasanalysis demonstrates no significative differences in terms of hematocrit (p=0.268), lactate (p=0.281) and mixed venous oxygen saturation (p=0.958). During postoperative days transaminase, total bilirubin, creatinkinase and creatinine didnít differ. Mean cardiopulmonary bypass time was 179+39 and 193+44 minutes, while mean cross-clamp time was 122+32 and 126+27 minutes respectively in Group 1 and Group 2.In all cases,virtually wall-less cannula provides an excellent exposure, collapsing right sections immediately after starting cardiopulmonary bypass.Table 1 summarize features and results of the two cohort of patients.
CONCLUSIONS:Wall-less cannula ensure higher flow, in most cases without vacuum assistance. Surgical set up resulted easier and quicker with excellent visibilty, reducing operative times. No advantages in terms of quality of cardiopulmonary bypass and enzymatic peaks were demonstrated.