Intra-operative Balloon Tamponade Of Robotic Port Sites Decreases Bleeding Complications In Robotic Endoscopic Mitral Valve Surgery
Kaitlin Grady1, Hiroto Kitahara2, Sarah Nisivaco1, Husam Balkhy1.
1The University of Chicago, chicago, IL, USA, 2The University of Chicago, Chicago, IL, USA.
BACKGROUND:Port sites are a common source of peri-operative bleeding in robotic cardiac surgery. Although hemostasis can be confirmed with direct 3D visualization, in some patients the presence of narrow intercostal spaces, preoperative anticoagulation, and coagulopathy after systemic heparinization may increase the risk of port site bleeding. We began liberally applying intraoperative balloon tamponade of the robotic port sites using a balloon-tipped Coude catheter whenever there was increased risk of perioperative bleeding, and hypothesized that it would decrease the rate of bleeding complications in robotic cardiac surgery. METHODS:All consecutive patients who underwent robotic endoscopic mitral valve surgery from August 2016 to July 2022 were reviewed. Liberal use of the catheter tamponade technique began in August 2019 for patients in whom there was significant bleeding from the port during the procedure (usually dripping from the robotic instrument), or if there were any concerns post-operatively. After undocking the robot, the catheter was inserted into the port site and balloon tamponade was applied while separating from cardiopulmonary bypass and until all the protamine was given. In the rare case of severe coagulopathy, the catheter was left inserted and removed in the ICU after the coagulopathy resolved. The cohorts were divided into pre balloon-tamponade group (Group-1, August 2016 - July 2019) and post balloon-tamponade group Group-2, August 2019 - July 2022), and postoperative outcomes were compared. RESULTS:Robotic endoscopic mitral valve surgery was performed in 320 patients during the study period. Demographics were similar between the groups. The incidence of return to OR for bleeding was 4.7 % (n = 6) in 128 patients in Group-1 and 0.5 % (n = 1) in 192 patients in Group-2 (p < 0.05). Group-2 had a higher rate of chest tube removal on postoperative day 1 compared to Group-1 (83 % vs 69 %), and lower total amount of chest tube drainage (515 +- 559 ml vs 706 +- 866 ml) (P < 0.05). CONCLUSIONS:Liberal use of intraoperative balloon-tamponade of robotic port sites may decrease the risk of bleeding complications in robotic mitral valve surgery. LEGEND:Balloon tamponade of left robotic port using Coude catheter during robotic mitral valve repair
Back to 2023 Abstracts