Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery. </jats:p></jats:sec>

Cosmetic and shoulder functional outcomes in posterolateral minithoracotomy atrial septal defect closure: A retrospective study

“…The wound can also be easily hidden by clothes. However, a right anterolateral thoracotomy 2–6 involves a smaller skin incision and does not require the lung to be pressed to the dorsal side to secure the surgical field. Furthermore, the smaller scar can be observed from the front and crosses the future breast line, which may cause maldevelopment of the breast and pectoral muscle.…”

“…1 Consequently, surgical ASD closure has become the second choice for treatment. There are many surgical approaches for ASD closure, including anterolateral thoracotomy, [2][3][4][5][6] transxiphoid approach without sternotomy, 7 lower ministernotomy, 8,9 and right sub-axillary vertical incision. 10 Each approach has its own set of advantages.…”

Robotic Surgery in the Adult Congenital Cardiac Patient: Back to the Future?

“…The difficulties of managing peripheral cannulation in smallbody surface area and low-weight patients, 5 the limitations of robotic arm conflict in small-chest patients, 6 and the need for a significant learning curve for the robotic platform were among the main reasons behind the lack of adoption by pediatric and congenital heart surgeons. Meanwhile, small thoracotomy, transaxillary approaches, and minimally invasive direct surgeries were growing among pediatric cardiac teams, allowing them to maintain their comfort zone with direct surgical techniques and avoiding the need of a costly device.…”