Abstract
BackgroundFemoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department.MethodsBetween July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups.ResultsIn patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications.ConclusionsCT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.
Highlights
Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves
The aim of the present study is to develop and evaluate a standardized operating procedure of computed tomography (CT) imaging for patients planned for minimally invasive cardiac surgery on the mitral valve
With time and due to individual cases of unexpected pathologies detected by CT angiography, this preoperative diagnostic tool was applied more liberally to an increasing proportion of patients planned for MICS, even when intraaortic balloon occlusion was not intended
Summary
Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Pathologies of the atrio-ventricular valves, especially mitral regurgitation, are a commonly observed cardiovascular disease leading to impaired physical strength with the Immohr et al Journal of Cardiothoracic Surgery (2021) 16:34 time and favourable cosmetic results [3, 6]. Vascular pathologies are known to be common in patients with a manifestation of atherosclerosis undergoing cardiac surgery [10, 11]. Snow et al [13] could show that even more than 80% of patients with aortic valve stenosis showed calcific aortic plaques in preinterventional computed tomography (CT). There is no general consensus on the value of preoperative contrast-enhanced CT for patients undergoing MICS mitral valve surgery
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