Avoiding vascular complications during minimally invasive, totally endoscopic intracardiac surgery

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 133; no. 4; pp. 1066 - 1070
• Main Authors: Jeanmart, Hugues, MD, Casselman, Filip P., MD, PhD, De Grieck, Yuan, MD, Bakir, Ihsan, MD, Coddens, Jose, MD, Foubert, Luc, MD, Van Vaerenbergh, Geert, MD, Vermeulen, Yvette, MSc, Vanermen, Hugo, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.04.2007; AATS/WTSA; Elsevier
• Subjects: Aged; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Catheterization, Peripheral - adverse effects; Endoscopy; Female; Femoral Artery - injuries; Humans; Iliac Artery - injuries; Male; Medical sciences; Middle Aged; Mitral Valve - surgery; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tricuspid Valve - surgery; Vascular Diseases - etiology; Vascular Diseases - prevention & control; 33; magnetic resonance imaging; MRI; 28; Heart; Complication; Minimally invasive surgery; Thorax; Endoscopy; Blood vessel
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.12.002

Objective The introduction of minimally invasive valve surgery has been associated with an increased use of peripheral vessel cannulation in cardiopulmonary bypass. These techniques are associated with potential problems at the aorta or cannulation sites. The goal of this study was to review and describe our current practice to avoid vascular problems during cannulation of peripheral vessels. Method Data collection for this study was done retrospectively by reviewing the files of all patients who underwent a minimally invasive mitral and/or tricuspid surgery in our institution from 1997 to the end of 2005. Results Our cohort of 978 patients revealed an overall rate of peripheral vascular complication of 1.0% with 44.4% presenting at the time of the surgery and 63.6% at long-term follow-up. Acute peripheral vascular problems were treated by simple graft replacement of the diseased segment in most cases. All aortic complications happened at the time of the surgery (complication rate of 0.9%) with 60% of them associated with cannulation problems. Most patients were treated by replacement of the ascending aorta. Conclusions A systematic and careful approach is associated with a low risk of vascular problems. Prevention and planning with precise surgical technique remain the main conditions to safely use peripheral cannulation and perfusion for minimally invasive mitral valve surgery.