Risk factors to predict leg ischemia in patients undergoing single femoral artery cannulation in minimally invasive cardiac surgery

Abstract

Background:

In peripheral cannulation for cardiopulmonary bypass, there is always a risk of ischemia in the extremities, caused by femoral artery cannulation. This report aimed to evaluate the outcome and the risk factors in patients undergoing minimally invasive cardiac surgery in mitral valve surgery.

Methods:

We retrospectively reviewed all minimally invasive mitral valve surgery at our institute from May 2014 to December 2016. Operative outcomes and intra-operative monitoring for distal leg saturation were measured by the near-infrared spectroscopy values. For post-operative outcomes, the creatinine phosphorus kinase level was measured for the assessment of leg ischemia. Risk factors were evaluated for the elevation of post-operative creatinine phosphorus kinase.

Results:

There were 162 patients who underwent single femoral artery cannulation for minimally invasive mitral valve surgery. The mean operation, cardiopulmonary bypass and aortic cross-clamp time were 212±44, 124±30, 76.6±22 minutes (min), respectively. The factors related to increased creatinine phosphorus kinase were male, body mass index, larger cannula size, operation time, cardiopulmonary bypass time and aortic cross-clamp time. The measurement of minimum near-infrared spectroscopy values did not show any association with creatinine phosphorus kinase elevation. There were significant associations between body mass index, cannula size and operation time and post-operative creatinine phosphorus kinase increase by multiple regression analysis. Two male patients had extremely high post-operative creatinine phosphorus kinase (18188 U/L and 16831 U/L) and they had high body mass index, large cannula size and longer operation time.

Conclusions:

In peripheral cannulation for minimally invasive cardiac surgery, body mass index, cannula size and operation time can be considered as risk factors for leg ischemia.

Keywords

minimally invasive cardiac surgery femoral artery cannulation leg ischemia near-infrared spectroscopy

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References

Svensson

Atik

Cosgrove

et al . Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 2010; 139: 926–932.

Murphy

Hessel

Groom

. Optimal perfusion during cardiopulmonary bypass: an evidence-based approach. Anesth Analg 2009; 108: 1394–1417.

Lamelas

Williams

Mawad

et al . Complications associated with femoral cannulation during minimally invasive cardiac surgery. Ann Thorac Surg 2016; 4975: 31364–31369.

Atluri

Goldstone

Fox

et al . Port access cardiac operations can be safely performed with either endoaortic balloon or Chitwood clamp. Ann Thorac Surg 2014; 98: 1579–1583.

Gammie

Zhao

Peterson

et al . Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010; 90: 1401–1408.

Katoh

Esato

Gohra

et al . Evaluation of brain oxygenation during selective cerebral perfusion by near-infrared spectroscopy. Ann Thorac Surg 1997; 64: 432–436.

Murkin

Adams

Novick

et al . Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg 2007; 104: 51–58.

Murkin

. NIRS: a standard for care for CPB vs. an evolving standard for selective cerebral perfusion. J Extra Corpor Technol 2009; 41: 11–14.

Vida

Padalino

Boccuzzo

et al . Near-infrared spectroscopy for monitoring leg perfusion during minimally invasive surgery for patients with congenital heart defects. J Thorac Cardiovasc Surg 2012; 143: 756–757.

10.

Schachner

Bonaros

Bonatti

et al . Near infrared spectroscopy for controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass. Eur J Cardiothorac Surg 2008 34: 1253–1254.

11.

Moscarelli

Fattouch

Casula

et al . What is the role of minimally invasive mitral valve surgery in high-risk patients? A meta-analysis of observational studies. Ann Thorac Surg 2016; 101: 981–989.

12.

Moscarelli

Casula

Speziale

et al . Can we use minimally invasive mitral valve surgery as a safe alternative to sternotomy in high-risk patients? Interact Cardiovasc Thorac Surg 2016; 22: 92–96.