Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

Abstract

For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs-the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation.

Cannulation Strategies for Minimally Invasive Cardiac Surgery

“…It has been conventionally believed that CTA should be obtained preoperatively in patients suspected of having aortic and/or peripheral vascular disease. 5,6 Due to its importance in evaluating patients 7 CTA has become routine in patients undergoing MICS in most high-volume programs. However, in the authors' experience, CTA is not routinely performed.…”

“…Risks involved with use of the IntraClude balloon clamp include balloon rupture, increased risk of myocardial damage, kidney injury, lower limb complications, and stroke rate in patients with aortoiliac disease. 5,14,15…”

“…Venous Cannulation in Patients with IVC Filters. Although IVC filters have often been considered a contraindication to peripheral venous cannulation, 5,19 it is typically still possible with the use of fluoroscopy. After venous puncture is obtained, the wire is advanced through the IVC filter under fluoroscopic guidance, followed by advancement of the venous cannula (Fig.…”

Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

“…This technique has proven its efficacy and neurological safety in adult MICS. [1][2][3][4][5][6][7][8] As per literature, the direct cannulation of CFA, however, has rarely been used in minimally invasive pediatric cardiac surgery. Common femoral artery and CFV are easily accessible at the femoral triangle.…”

“…Similarly, femoral vein is sufficiently large and easily accessible for venous return during CPB, making it a preferred route for establishment of CPB in adult patients undergoing MICS. [1][2][3][4][5][6][7][8] In pediatric patients, when dual-stage femoral venous cannula cannot be inserted because of the small size of femoral vein, two options are available. One option is placement of percutaneous venous cannula through internal jugular vein and second option is direct SVC cannulation.…”