Mid-term results of peripheric cannulation after port-access surgery

Abstract

Several minimally invasive approaches, avoiding median sternotomy, have been described within the last few years for cardiac surgery. Femoral arterial and venous cannulation for extracorporeal perfusion are required for many of these operations. The aim of this report is to assess the long-term outcomes of femoral cannulations in patients who underwent minimally invasive procedures. One hundred and sixty patients underwent operations by the port-access method between January 2002 and October 2006. Cardiopulmonary bypass was established by femoral artery-vein cannulation, and a transthoracic clamp was used for the aortic occlusion. One hundred and twenty-one patients were under follow-up in the outpatient clinic and 85 patients underwent Doppler ultrasonography (US) for femoral arterial and venous stenosis. The mean follow-up was 27.9 months (range 1-57 months). There were three hospital mortalities (1.86%), and five late mortalities in this series. The mean follow-up for the Doppler examination was 20.54 months (range 1-56 months). There were two seromas and three wound complications (2.48%), all of which healed after outpatient treatment. All of the flow patterns of the common femoral arteries (CFA) were triphasic except in three of the patients. Three patients (2.48%) were found to have arterial stenosis. One patient with intermittant claudication underwent percutaneous dilatation and stenting of the CFA. Doppler US detected luminal narrowing in two patients who had been having no symptoms, and they are being followed in the outpatient clinic without any complaints. We found a chronic recanalized thrombotic change in the common femoral vein (CFV) in one patient (0.63%). Our study demonstrates vessel patency and/or stenosis in patients without complaints. In conclusion, femoral artery and vein cannulation for port-access surgery with transthoracic clamping can be performed successfully with excellent results in the mid-term.

Distal Leg Protection for Peripheral Cannulation in Minimally Invasive and Totally Endoscopic Cardiac Surgery

“…Glower et al [1999] experienced minor or major complications after femoral cannulation in up to 10% of their patients who underwent port-access minimally invasive cardiac surgery. Other authors have reported rapid improvement of clinical symptoms, even in patients who experienced major complications after peripheral cannulation, such as major leg ischemia or local dissection [Sagbas 2007]. In our hands, 2 of the 4 complications noted were not observed at the side of introduction of the balloon endoocclusion catheter but at the contralateral side, which was cannulated with an additional arterial-perfusion cannula that was required for adequate CPB flow.…”

Routine use of self-expanding venous cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive cases☆

“…Considering the growing number of indications for remote venous cannulation, which follows the development for small access open-heart surgery [16,17], as well as the growth of redo open-heart surgery [18,19], and other complex procedures [20,21], the advent of self-expanding venous cannulas is a major step forward in optimization of cardiopulmonary bypass. Better venous drainage with remote venous cannulation not only allows for higher pump flows and improved end-organ perfusion, but is also essential for a bloodless operative field, which in turn simplifies the surgical procedure.…”

Right Ventricular Perforation during Femoral Venous Cannulation – Lessons Learned

“…No significant haemopericardium was found but the tip of the venous cannula was seen perforating the apex of the RV (Fig. 2) [1,2]. The routine use of TOE is likely to reduce the rate of more serious complications such as cardiac injury.…”