Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

Ji-Hyun Chin,In-Cheol Choi,Eun-Ho Lee,Jong-Il Kim

doi:10.1186/s12871-017-0347-x

Ji-Hyun Chin, In-Cheol Choi + Show 2 more

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https://doi.org/10.1186/s12871-017-0347-x

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Abstract

BackgroundThe determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.MethodsThe patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon’s direct inspection in the surgical field was performed. The range −1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.ResultsA total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon’s inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05–0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.ConclusionsPreoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.Trial registrationThis study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477).

Highlights

The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass
We have shown that cardiac computed tomography (CT) is a valuable tool for predicting the optimal depth of superior vena cava (SVC) cannulae by comparing the equivalence of the distance measured on cardiac CT and the distance verified by a surgeon’s direct inspection
The final depth for SVC cannulae to be inserted might be the sum of the distance from the upper border of the clavicular sternal head to the SVCRA junction which is measured in cardiac CT and the distance from the puncture point to the upper border of the clavicular sternal head which is dependent on the insertion point

Summary

Introduction

The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae. To reduce the surgical incision size in minimally invasive cardiac surgery, percutaneous insertion of superior vena cava (SVC) cannulae via the internal jugular vein is necessary for venous drainage during cardiopulmonary bypass. Several imaging tools, including echocardiography and cardiac computed tomography (CT), have been used to assess the functional and anatomical abnormalities of a cardiac disease prior to cardiac surgery. In addition to its original role in diagnosis, numerous cardiac CT-obtained measurements, such as length or width, of structures adjacent to the heart might enable clinicians to predict the adequate size or depth of an insertion device

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