Mid-Term Results of Peripheral Cannulation After Robotic Cardiac Surgery

Abstract

IntroductionVarious surgical procedures for minimally invasive cardiac surgery have been described in recent decades as alternatives to median sternotomy. Cardiopulmonary bypass via femoral arterial and venous cannulation is the foundation of these procedures. In this study, we evaluated the mid-term outcomes of femoral cannulation performed with U-suture technique in patients undergoing robotic heart surgery.MethodsA total of 216 patients underwent robotic-assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients.ResultsHospital mortality occured in 4 of the 216 (1.85%) cases, but there was no late mortality in this patient group. Postoperatively, seroma (n=9, 4.69%) and cannulation site infection (n=3, 1.56%) were managed with outpatient treatment. DUS in 145 patients revealed triphasic flow pattern in the common femoral arteries in all patients except for 2 (1.38%). These patients were determined to have asymptomatic arterial stenosis. Chronic recanalized thrombus in the common femoral vein was also detected in 2 (1.38%) patients.ConclusionFemoral artery cannulation with the U-suture technique can be successfully performed in robotic-assisted cardiac surgery, with good mid-term results.

Prolonged prophylactic effects of gabapentin on status epilepticus-induced neocortical injury

“…8D ). These events resembled the “epileptiform” responses in partially isolated cortex ( Graber and Prince, 2004 ; Prince and Tseng, 1993 ; Sen et al, 2018 ), and were not recorded in slices from control animals. We used the “coastline index” of the LFP (Methods, ( Korn et al, 1987 ) as a measure of circuit activity in control and 10 and 30d post FSE.…”

“…In the present study, the long-lasting increases in colocalized VGLUT1-IR and PSD95-IR puncta, together with increased frequency of sEPSCs and mEPSCs and occurrence of epileptiform burst activity, indicate the development of aberrant excitatory synaptic connectivity within cortical networks. Decreased density of PV interneurons and the frequency of mIPSCs, suggests that disinhibition contributes to the hyperexcitability, as in other models ( Gu et al, 2017 ; Jin et al, 2014 ; Sen et al, 2018 ) and in human epileptogenic lesions ( de Lanerolle et al, 1989 ; DeFelipe, 1999 ; Marco et al, 1996 ; Medici et al, 2016 ). The increase in excitatory connectivity following neocortical FSE in these experiments is common in other epilepsy models ( Dancause et al, 2005 ; Marco and DeFelipe, 1997 ; Shao and Dudek, 2004 ; Takahashi et al, 2016 ; Tauck and Nadler, 1985 ) and human epileptic tissue ( Marco and DeFelipe, 1997 ).…”

Peripheral vs. Central Cannulation in Cardiac Reoperations: Technical Considerations and Outcomes

“…Then, a 2-3 inch of groin incision was made and the femoral artery and vein were exposed. A 5/0 polypropylen suture was placed circularly on the vein, and double parallel ‘U’ sutures on the artery [ 5 ] . The femoral vein was cannulated first by a suitable size Medtronic Edwards Lifesciences (18F-28F, Irvine, California, United States of America) femoral cannula, then Medtronic DLP femoral artery cannula (17F-21F, Minneapolis, MN, United States of America) was inserted between the double parallel ‘U’ suture ( Figure 1B ).…”

Cannulas and Cannulation Options for Minimally Invasive Surgery

“…Furthermore, although severe peripheral vascular disease (PVD) and a moderate to severe atheromatous aorta may increase the risk of embolic phenomena with retrograde flow, with optimal patient selection, this risk has been repeatedly demonstrated as not significantly greater than that associated with traditional central cannulation with antegrade flow. 3,[6][7][8]…”

“…When compared with a conventional sternotomy, alternative access offers patients the potential benefits of decreased infection risk, reduced transfusion requirements, decreased length of admission, quicker return to normal activity, and, perhaps most important for patients, improved cosmesis. [1][2][3] The smaller incisions used in MICS and the distance from the mediastinal structures can make traditional central cannulation challenging. Furthermore, with MICS using a very small operative field, moving additional instrumentation out of the field is ideal, and as such, alternative cannulation strategies are frequently employed.…”