Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery
Objective: Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. Methods: A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016–2018. Right side femoral art...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958421006539 |
| _version_ | 1811336039875215360 |
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| author | Yi-Chia Wang Nai-Hsin Chi Ya-Chen Wang Yih-Sharng Chen, MD.PhD Chi-Hsiang Huang |
| author_facet | Yi-Chia Wang Nai-Hsin Chi Ya-Chen Wang Yih-Sharng Chen, MD.PhD Chi-Hsiang Huang |
| author_sort | Yi-Chia Wang |
| collection | DOAJ |
| description | Objective: Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. Methods: A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016–2018. Right side femoral artery and femoral vein are used for bypass route. We set cardiopulmonary bypass flow to 2.5–3.0 L/min/m2, and adjust pump flow rate to achieve adequate cerebral oxygenation. The upper limit of arterial cannula pressure was 250 mmHg. We divided our patients into four groups by average pump flow 2.2 L/min/m2 and average mean arterial pressure 45 mmHg. Compared outcomes included surgical mortality, hospital stay, ventilator use, neurological outcomes, acute kidney injury, distal limb saturations, and post-operative clinical complications. Results: We included 117 patients in this study, and all participants had successful mitral valve repair or replacement. Our longest CPB duration was 210 minutes. Surgical mortality was 1.7%. Hemorrhagic stroke rate was 1.7%, and there was no ischemic stroke event. CPB flow did not affect survival rate, hospital stay, intensive care unit stay, or serum lactate in post-operative day 1, but serum creatinine (mg/dL) level increased transiently in patients with low pump flow group(0.9 ± 0.4 vs 1.3 ± 0.7,p < 0.05). Cannulation limb had decreased oxygenation during CPB, but their oxygenation all recovered after surgery. No limb ischemia event happened. Conclusion: Retrograde arterial perfusion is a safe method for minimally invasive cardiac surgery less than 3.5 hours under mild hypothermic status. |
| first_indexed | 2024-04-13T17:32:44Z |
| format | Article |
| id | doaj.art-a4073ff620cb450c84ffae1b819478db |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-04-13T17:32:44Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-a4073ff620cb450c84ffae1b819478db2022-12-22T02:37:30ZengElsevierAsian Journal of Surgery1015-95842022-10-01451018491854Retrograde arterial perfusion and its outcome in robotic mitral-valve surgeryYi-Chia Wang0Nai-Hsin Chi1Ya-Chen Wang2Yih-Sharng Chen, MD.PhD3Chi-Hsiang Huang4Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, TaiwanDepartment of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, Taiwan; Corresponding author. Department of Anaesthesiology, National Taiwan University College of Medicine and National University Hospital, 7 Chung-Shan South Road, Taipei, 10002, Taiwan.Objective: Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. Methods: A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016–2018. Right side femoral artery and femoral vein are used for bypass route. We set cardiopulmonary bypass flow to 2.5–3.0 L/min/m2, and adjust pump flow rate to achieve adequate cerebral oxygenation. The upper limit of arterial cannula pressure was 250 mmHg. We divided our patients into four groups by average pump flow 2.2 L/min/m2 and average mean arterial pressure 45 mmHg. Compared outcomes included surgical mortality, hospital stay, ventilator use, neurological outcomes, acute kidney injury, distal limb saturations, and post-operative clinical complications. Results: We included 117 patients in this study, and all participants had successful mitral valve repair or replacement. Our longest CPB duration was 210 minutes. Surgical mortality was 1.7%. Hemorrhagic stroke rate was 1.7%, and there was no ischemic stroke event. CPB flow did not affect survival rate, hospital stay, intensive care unit stay, or serum lactate in post-operative day 1, but serum creatinine (mg/dL) level increased transiently in patients with low pump flow group(0.9 ± 0.4 vs 1.3 ± 0.7,p < 0.05). Cannulation limb had decreased oxygenation during CPB, but their oxygenation all recovered after surgery. No limb ischemia event happened. Conclusion: Retrograde arterial perfusion is a safe method for minimally invasive cardiac surgery less than 3.5 hours under mild hypothermic status.http://www.sciencedirect.com/science/article/pii/S1015958421006539Cardiopulmonary bypassMinimally invasive cardiac surgeryRetrograde arterial perfusion |
| spellingShingle | Yi-Chia Wang Nai-Hsin Chi Ya-Chen Wang Yih-Sharng Chen, MD.PhD Chi-Hsiang Huang Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery Asian Journal of Surgery Cardiopulmonary bypass Minimally invasive cardiac surgery Retrograde arterial perfusion |
| title | Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery |
| title_full | Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery |
| title_fullStr | Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery |
| title_full_unstemmed | Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery |
| title_short | Retrograde arterial perfusion and its outcome in robotic mitral-valve surgery |
| title_sort | retrograde arterial perfusion and its outcome in robotic mitral valve surgery |
| topic | Cardiopulmonary bypass Minimally invasive cardiac surgery Retrograde arterial perfusion |
| url | http://www.sciencedirect.com/science/article/pii/S1015958421006539 |
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