Efficacy of regional saturation of oxygen monitor using near-infrared spectroscopy for lower limb ischemia during minimally invasive cardiac surgery

Abstract

Lower limb ischemia with an occlusive cannula is a potential complication of minimally invasive cardiac surgery (MICS). We evaluated intraoperative local oxygen supply-demand balance by monitoring regional saturation of oxygen (rSO) using near-infrared spectroscopy (NIRS), and analyzed the correlation between cannula size and fluctuation range of rSO. Fifty-four patients undergoing MICS surgery using femoral artery cannulation from April 2015 to August 2016 were enrolled. The rSO of both the cannulated and uncannulated lower limbs were measured using NIRS. The association between the decline of rSO from baseline (delta-rSO) and the ratio of the cannula diameter to the femoral artery diameter (Cd/FAd) was analyzed. Of the 54 patients, 16 (30%) (Group 1) showed values over 0.65 for Cd/FAd, and the remaining 38 (70%) (Group 2) showed values under 0.65. No patient developed postoperative lower limb ischemia. No patient was treated with an ipsilateral distal perfusion cannula. There were significant differences between Group 1 and Group 2 in the decrease of rSO at the point of cannulation on the cannulated limb. In the lower limb on the cannulated side, delta-rSO showed a significant decrease in Group 1 compared to Group 2 (Group 1 vs Group 2: 19.9 vs 11.0%; p < 0.001). Delta-rSO was significantly correlated with body surface aera (BSA), but not with gender or age. Decreasing rSO correlates with the Cd/FAd index. Low BSA, Cd/Fad > 0.65 is considered as the risk factor for decline of rSO in cannulated limb in MICS.

Utility of Ultrasonographic Assessment of Distal Femoral Arterial Flow during Minimally Invasive Valve Surgery

“…Size discrepancy between the arterial cannula and the femoral artery is a suspected risk factor for lower limb ischemia. 8 , 14) A correlation between the cannula size relative to the femoral artery diameter and distal femoral artery flow velocity was observed in the present study, but the correlation was weak. From our results, we considered there were other factors determining the blood flow below cannulation site.…”

“…One of the methods used to monitor oxygenation in the lower leg is NIRS; this monitoring minimizes the risks associated with peripheral cannulation during MICS. 8) Inadequate perfusion to the lower extremity can develop during femoral arterial cannulation, and may result from decreased blood flow owing to insertion of the arterial cannula, displacement of the cannula, temporary obstruction through kinking, embolic events, or arterial spasm. Using NIRS to continuously monitor blood flow, poor oxygenation due to inadequate perfusion can be treated immediately.…”

“… 9) We also routinely use NIRS during MICS along with the ultrasonographic assessment. Toya et al 8) reported that relative changes from the baseline value were more useful than the absolute rSO 2 value evaluating intraoperative lower limb ischemia in MICS. According to their report, we diagnosed the possibility of decreased blood flow to the lower leg when a >40% decrease from baseline rSO 2 values in the cannulated leg or in the non-cannulated opposite side value was observed.…”

Journal of Artificial Organs 2018: the year in review

“…Shirakawa et al [9] constructed 3D models of six prolapsed mitral valves for surgical assessment, and evaluated how accurately the models could replicate individual valve dimensions, to determining the complex geometry of mitral valve prolapse. They concluded that the 3D valve models could replicate the actual mitral valve prolapses within acceptable dimensional differences, and are useful for better 3D valve creation and better surgical planning with reliable 3D valve models.…”

Regional oxygen saturation change rate for detection of leg ischemia in minimally invasive cardiac surgery

“…6,8 To our knowledge, there are only three English articles about the clinical use of NIRS to monitor leg ischemia during MICS. [9][10][11] We had introduced the NIRS monitoring system for distal leg ischemia during MICS in 2013 and established the criteria for initiation of distal perfusion cannulas to distal legs.…”