Perfusion Strategy for Minimally Invasive Cardiac Surgery

Keywords: peripheral cannulation, preoperative CT scan, cardiopulmonary bypass, minimally invasive CABG, TCRAT, minimally invasive valve surgery

Abstract

Minimally invasive cardiac surgery (MICS) has a number of proven advantages compared to median sternotomy. Safe cannulation and perfusion are some of the main components of the success of MICS.

The aim. To present our perfusion strategy and describe the methods of cannulation, technical features, contraindications and potential complications.

Materials and methods. We examined the results of 1088 adult patients who underwent primary cardiac surgery in our hospital (coronary artery bypass grafting, valve surgery, aortic surgery, left ventricle repair, congenital cardiac surgery and combined procedures) from July 2017 to May 2021. Of these, 851 patients were qualified for MICS. To select a safe cannulation strategy, we performed contrast enhanced computed tomography (CT) of the aorta and main branches for all the patients, also we calculated the body surface area according to the DuBois and DuBois formula.

Results. We performed 838 minimally invasive on-pump procedures, which is 98.5% of all patients qualified for MICS. According to the results of the preoperative CT scan, 13 (1.5%) patients were not operated with the minimally invasive approach due to the hazards related to the provision of cardiopulmonary bypass. Peripheral cannulation was performed in 754 (90%) patients and an alternative cannulation site was selected in 62 (8.2%) patients based on preoperative CT data. There were 10 (1.32%) patients who developed major complications (stroke, acute aortic dissection, acute renal failure requiring hemodialysis) after peripheral cannulation.

Conclusions. Preoperative CT scan is mandatory for planning a perfusion strategy in minimally invasive cardiac surgery. The required surgical techniques should include cannulation of the right and left femoral and right axillary arteries.

References

  1. Guo MH, Wells GA, Glineur D, Fortier J, Davierwala PM, Kikuchi K, Lemma MG, Mishra YK, McGinn J, Ramchandani M, Rabindra P, Nambala S, Chiu KM, Kiaii B, Gibson S, Ruel M. Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: The MIST trial. Contemp Clin Trials. 2019;78:140-5. https://doi.org/10.1016/j.cct.2019.01.006
  2. Nissen AP, Miller CC 3rd, Thourani VH, Woo YJ, Gammie JS, Ailawadi G, Nguyen TC. Less Invasive Mitral Surgery Versus Conventional Sternotomy Stratified by Mitral Pathology. Ann Thorac Surg. 2021;111(3):819-27. https://doi.org/10.1016/j.athoracsur.2020.05.145
  3. Grant SW, Hickey GL, Modi P, Hunter S, Akowuah E, Zacharias J. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart. 2019;105(10):783-9. https://doi.org/10.1136/heartjnl-2018-314049
  4. Elmahdy HM, Nascimento FO, Santana O, Lamelas J. Outcomes of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach. J Heart Valve Dis. 2013;22(5):735-9.
  5. Alnajar A, Aberle C, Lamelas J. Minimally invasive, simplified double‐layer left atrial appendage closure. J Card Surg. 2020;35(6):1322-4. https://doi.org/10.1111/jocs.14563
  6. Welp HA, Herlemann I, Martens S, Deschka H. Outcomes of aortic valve replacement via partial upper sternotomy versus conventional aortic valve replacement in obese patients. Interact Cardiovasc Thorac Surg. 2018;27(4):481-6. https://doi.org/10.1093/icvts/ivy083
  7. Lamelas J, Sarria A, Santana O, Pineda AM, Lamas GA. Outcomes of Minimally Invasive Valve Surgery Versus Median Sternotomy in Patients Age 75 Years or Greater. Ann Thorac Surg. 2011;91(1):79-84. https://doi.org/10.1016/j.athoracsur.2010.09.019
  8. Santana O, Reyna J, Benjo AM, Lamas GA, Lamelas J. Outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease. Eur J Cardiothorac Surg. 2012;42(4):648-52. https://doi.org/10.1093/ejcts/ezs098
  9. Babliak O, Demianenko V, Melnyk Y, Revenko K, Pidgayna L, Stohov O. Complete Coronary Revascularization via Left Anterior Thoracotomy. Innovations (Phila). 2019;14(4):330-41. https://doi.org/10.1177/1556984519849126
  10. Babliak OD, Demianenko VM, Babliak DY, Marchenko AI, Revenko KA, Pidgaina LV. [Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery]. Ukrainian Journal Of Cardiovascular Surgery. 2020;(1(38)):23-8. Ukrainian. https://doi.org/10.30702/ujcvs/20.3803/013023-028
  11. Crooke GA, Schwartz CF, Ribakove GH, Ursomanno P, Gogoladze G, Culliford AT, Galloway AC, Grossi EA. Retrograde Arterial Perfusion, Not Incision Location, Significantly Increases the Risk of Stroke in Reoperative Mitral Valve Procedures. Ann Thorac Surg. 2010;89(3):723-9; discussion 729-30. https://doi.org/10.1016/j.athoracsur.2009.11.061
  12. Lamelas J, Williams RF, Mawad M, LaPietra A. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery. Ann Thorac Surg. 2017;103(6):1927-32. https://doi.org/10.1016/j.athoracsur.2016.09.098
  13. Lamelas J, Aberle C, Macias AE, Alnajar A. Cannulation Strategies for Minimally Invasive Cardiac Surgery. Innovations (Phila). 2020;15(3):261-9. https://doi.org/10.1177/1556984520911917
  14. Nakamura Y, Nishijima S, Kuroda M, Nakayama T, Tsuruta R, Yoshiyama D, Yasumoto Y, Ito Y. Perfusion strategy using axillary or femoral cannulation for minimally invasive cardiac surgery: experience in 270 patients with computed tomography-based criteria. Eur J Cardiothorac Surg. 2021;59(6):1200-7. https://doi.org/10.1093/ejcts/ezaa469
  15. Grossi EA, Loulmet DF, Schwartz CF, Solomon B, Dellis SL, Culliford AT, Zias E, Galloway AC. Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurologic complications. Ann Thorac Surg. 2011;92(4):1346-9; discussion 1349-50. https://doi.org/10.1016/j.athoracsur.2011.04.055
  16. Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. Less-Invasive Mitral Valve Operations: Trends and Outcomes From The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010;90(5):1401-1410.e1. https://doi.org/10.1016/j.athoracsur.2010.05.055
  17. Murzi M, Cerillo AG, Miceli A, Bevilacqua S, Kallushi E, Farneti P, Solinas M, Glauber M. Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients. Eur J Cardiothorac Surg. 2013;43(6):e167-72. https://doi.org/10.1093/ejcts/ezt043
  18. Crawford TC, Magruder JT, Grimm JC, Lee SR, Suarez-Pierre A, Lehenbauer D, Sciortino CM, Higgins RS, Cameron DE, Conte JV, Whitman GJ. Renal Failure After Cardiac Operations: Not All Acute Kidney Injury Is the Same. Ann Thorac Surg. 2017;104(3):760-6. https://doi.org/10.1016/j.athoracsur.2017.01.019
  19. LaPietra A, Santana O, Mihos CG, DeBeer S, Rosen GP, Lamas GA, Lamelas J. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. J Thorac Cardiovasc Surg. 2014;148(1):156-60. https://doi.org/10.1016/j.jtcvs.2013.08.016
  20. O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V, Kurlansky PA, Furnary AP, Cleveland JC Jr, Lobdell KW, Vassileva C, Wyler von Ballmoos MC, Thourani VH, Rankin JS, Edgerton JR, D’Agostino RS, Desai ND, Edwards FH, Shahian DM. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2—Statistical Methods and Results. Ann Thorac Surg. 2018;105(5):1419-28. https://doi.org/10.1016/j.athoracsur.2018.03.003
  21. den Harder AM, de Heer LM, Meijer RC, Das M, Krestin GP, Maessen JG, Bogers AJ, de Jong PA, Leiner T, Budde RP. Effect of computed tomography before cardiac surgery on surgical strategy, mortality and stroke. Eur J Radiol. 2016;85(4):744-50. https://doi.org/10.1016/j.ejrad.2016.01.003
  22. Sandner SE, Nolz R, Loewe C, Gregorich M, Heinze G, Andreas M, Kolh P, Zimpfer D, Laufer G. Routine preoperative aortic computed tomography angiography is associated with reduced risk of stroke in coronary artery bypass grafting: a propensity-matched analysis. Eur J Cardiothorac Surg. 2020;57(4):684-90. https://doi.org/10.1093/ejcts/ezz237
  23. Rosner MH, Okusa MD. Acute Kidney Injury Associated with Cardiac Surgery. Clin J Am Soc Nephrol. 2006;1(1):19-32. https://doi.org/10.2215/cjn.00240605
  24. Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, Danesi TH, Kim JC, Nayak A, Neri M, Virzi GM, Brocca A, Scalzotto E, Salvador L, Ronco C. Cardiac Surgery-Associated Acute Kidney Injury. Cardiorenal Med. 2013;3(3):178-99. https://doi.org/10.1159/000353134
  25. O’Neal JB, Shaw AD, Billings FT 4th. Acute kidney injuryfollowing cardiac surgery: current understanding and future directions. Crit Care. 2016;20(1):187. https://doi.org/10.1186/s13054-016-1352-z
  26. Williams ML, Sheng S, Gammie JS, Rankin JS, Smith PK, Hughes GC. Aortic Dissection as a Complication of Cardiac Surgery: Report From The Society of Thoracic SurgeonsDatabase. Ann Thorac Surg. 2010;90(6):1812-6; discussion 1816-7.https://doi.org/10.1016/j.athoracsur.2010.05.023
Published
2021-12-22
How to Cite
Babliak, O. D., Demianenko, V. M., Marchenko, A. I., Pidgaina, L. V., Babliak, D. Y., & Stohov, O. S. (2021). Perfusion Strategy for Minimally Invasive Cardiac Surgery. Ukrainian Journal of Cardiovascular Surgery, (4 (45), 90-98. https://doi.org/10.30702/ujcvs/21.4512/BD061-9098
Section
GENERAL ISSUES of CARDIOVASCULAR SURGERY