Percutaneous cannulation for cardiopulmonary bypass in minimally invasive surgery is associated with reduced groin complications.

Autor:	Moschovas A; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Amorim PA; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Nold M; Department of Medical Statistics, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Faerber G; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Diab M; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Buenger T; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany., Doenst T; Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany.
Jazyk:	angličtina
Zdroj:	Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2017 Sep 01; Vol. 25 (3), pp. 377-383.
DOI:	10.1093/icvts/ivx140
Abstrakt:	Objectives: Femoral cutdown is standard in most centres if groin cannulation is used for cardiopulmonary bypass in minimally invasive cardiac surgery (MICS). Arterial closure devices (ACDs) allow placement of larger cannulas percutaneously, but its benefit in MICS is unclear. We assessed our results with percutaneous groin cannulation using ACDs in comparison with conventional surgical access in patients undergoing MICS. Methods: We reviewed 445 consecutive patients having undergone MICS between October 2010 and March 2015. Of those, 92 (21%) were performed with conventional surgical access to the groin vessels and 353 (79%) with the use of ACDs. Results: Operative risk was higher in the ACD group [logistic EuroSCORE 7.9% (SD: 8.1) vs 10.6% (SD: 12.3); P = 0.010]. The use of ACDs significantly reduced operation time [193 min (SD: 43.8) vs 173 min (SD: 47.1); P < 0.001] and hospital stay [Cutdown: median 9 days (8, 14); ACD: median 9 days (7, 12), P = 0.040] without affecting the time to full mobilization. The incidence of any complication was significantly lower in the ACD group (2.3% vs 8.7%; P = 0.007). Complications with conventional cannulation consisted of lymphatic fistulae (n = 4), wound infections (n = 2), stenosis (n = 1) and haematoma (n = 1). In the ACD group, there were local dissections (n = 2) and stenoses (n = 3). There was 1 haematoma in both groups. There were 2 vascular injuries in the ACD group (n = 2), leading to conversion to surgical access. Conclusions: Percutaneous groin cannulation using ACDs for establishing cardiopulmonary bypass in minimally invasive valve surgery significantly reduces groin complications, operation time and hospital stay. However, the remaining complications are mainly of vascular nature versus wound infection and lymph fistulae with cutdown. (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu