Remote access perfusion for minimally invasive cardiac surgery: to clamp or to inflate?
| Autor: | Christoph Krapf, Michael Grimm, Johannes Bonatti, Thomas Schachner, Nikolaos Bonaros, Herbert Hangler, Ludwig Müller, Peter Wohlrab, Sarah Häußinger |
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| Rok vydání: | 2013 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Adolescent medicine.medical_treatment Myocardial Reperfusion law.invention Young Adult law medicine.artery Ascending aorta Minimally invasive cardiac surgery Cardiopulmonary bypass Medicine Humans Minimally Invasive Surgical Procedures Minimally invasive direct coronary artery bypass surgery Myocardial infarction Cardiac Surgical Procedures Child Perioperative Period Aged Retrospective Studies Aortic dissection Aged 80 and over Aorta Cardiopulmonary Bypass business.industry General Medicine Perioperative Middle Aged medicine.disease Surgery Treatment Outcome Anesthesia Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 44(5) |
| ISSN: | 1873-734X |
| Popis: | OBJECTIVES: Endoaortic balloon occlusion (EBO) and aortic transthoracic clamping (TTC) are the dominant methods of remote access perfusion (RAP) in minimally invasive cardiac surgery. The aim of the study was to compare the two methods in terms of feasibility, success and complications. METHODS: From June 2001 to November 2011, 307 (median age; range) (57; 16–77 years) and 460 (62; 11–88 years) patients underwent minimally invasive CABG, ASD and mitral valve surgery using EBO and TTC, respectively. Perioperative procedure feasibility, success and postoperative complications were recorded. RESULTS: Overall 30-day mortality was 0 and 2 (0.43%) for the EBO and TTC groups, respectively (P = 0.52). Overall and RAP-associated conversions were noted in 21 (6.8%) and 4 (1.3%) patients in the EBO and in 9 (2%) and 6 (1.3%) patients in the TTC groups (P < 0.001, P = 1.00, respectively). Incidence of major complications, including aortic dissection, major vessel perforation, injury of intrapericardial structures, limb ischaemia, myocardial infarction and neurologic events, was similar [EBO: 12 (4%); TTC: 11 (2.4%); P = 0.23]. Minor complications such as minor vessel injury, groin bleeding or lymphatic fistula were noted in 31 (10.1%) and 35 (7.6%), respectively (P = 0.23). Successful RAP procedures defined as absence of RAP-associated conversions and major complications were equal [EBO: 295 (96%); TTC: 449 (97.6%); P = 0.23]. Complications detected during follow-up included pain: 30 of 249 (12%) and 13 of 279 (4.7%) (P = 0.002); sensational disturbances: 60 of 249 (24.1%) and 40 of 278 (14.4%) (P = 0.005) and wound-healing complications: 49 of 249 (19.7%) and 42 of 277 (15.2%) (P = 0.172) for EBO and TTC, respectively. CONCLUSIONS: RAP can be successfully and safely implemented in minimally invasive cardiac surgery. EBO and transthoracic clamping of the ascending aorta are performing equally in terms of feasibility and procedural success. |
| Databáze: | OpenAIRE |
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