Elevated Stroke Risk Associated With Femoral Artery Cannulation During Mitral Valve Surgery

Bedeir, Kareem; Reardon, Michael J.; Ramchandani, Mahesh; Singh, Karanbir; Ramlawi, Basel

doi:10.1053/j.semtcvs.2015.06.008

Cited by 28 publications

(25 citation statements)

References 17 publications

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“…Recent series were also able to demonstrate, that mini-MVS can be performed without significant differences in mortality and long-term survival compared with conventional MVS ( Cheng et al, 2011 ; Goldstone et al, 2013 ; Moscarelli et al, 2016a ; Sundermann, Czerny & Falk, 2015 ). The elevated stroke rate after mini-MVS as a consequence of peripheral cannulation or retrograde perfusion is considered to be disadvantage of this approach ( Bedeir et al, 2015 ). However, some newer publications disprove these findings.…”

Section: Discussionmentioning

confidence: 99%

Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

Mkalaluh¹,

Szczechowicz²,

Dib³

et al. 2018

PeerJ

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BackgroundMinimally invasive mitral valve surgery (MVS) via right mini-thoracotomy has recently attracted a lot of attention. Minimally invasive MVS shows postoperative results that are comparable to those of conventional MVS through the median sternotomy as per various earlier studies.MethodsBetween 2000 and 2016, a total of 669 isolated mitral valve procedures for isolated mitral valve regurgitation were performed. A propensity score-matched analysis was generated for the elimination of the differences in relevant preoperative risk factors between the cohorts and included 227 patient pairs. Only degenerative mitral valve regurgitation was included. The aim of our study was to examine if the minimally MVS is superior to the conventional approach through sternotomy based on a retrospective propensity-matched analysis. The primary endpoints were early mortality and long-term survival. The secondary endpoints included postoperative complications.ResultsThe in-hospital mortality rate was significantly higher within the conventional sternotomy cohort (3.1%, n = 7 vs 0.4%, n = 1 for the minimally invasive cohort; p = 0.032). The incidence of stroke and exploration for bleeding was comparable. In contrast, the necessity for dialysis was significantly lower in the minimally invasive cohort (p = 0.044). Postoperative pain was not significantly lower in the minimally invasive MVS cohort (p = 0.862). While patients who underwent minimally invasive MVS experienced longer bypass and cross-clamp times, their lengths of stay in the intensive care unit and in the hospital, did not differ from the conventionally operated collective (p = 0.779 and p = 0.516), respectively. The mitral valve repair rate of 81.1% in the minimally invasive cohort was significantly superior to that of the conventional approach, which was 46.3% (p < 0.0001). The one-, five-, and 10-year survival rates were significantly higher in the minimally invasive cohort compared to the conventional approach (96%, 90%, and 84% vs. 89%, 85%, and 70%; log rank p = 0.004).ConclusionDespite prolonged cardiopulmonary bypass and cross-clamping times, the minimally invasive MVS may be considered a safe approach that is equivalent to standard median sternotomy with lower early mortality and superior long-term survival.

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Section: Discussionmentioning

confidence: 99%

Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

Mkalaluh¹,

Szczechowicz²,

Dib³

et al. 2018

PeerJ

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“…28,29 Proposed culprits included endoaortic balloon occlusion and inadequate deairing and femoral artery cannulation. [30][31][32] On the other hand, Le Pietra et al 33 analyzed 1,501 MIVS patients and did not show this association. Until a randomized controlled trial is conducted to put this concern to rest, we are inclined towards transthoracic aortic clamping, removal of air under transesophageal echocardiographic (TEE) guidance, and recommending cannulation strategy dependent upon the surgeon's experience and comfort level.…”

Section: Performance Of Minimally Invasive Aortic Valve Surgerymentioning

confidence: 99%

Aortic Valve Surgery: Minimally Invasive Options

Ramlawi

Bedeir

Lamelas

2016

Methodist DeBakey Cardiovascular Journal

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Minimally invasive aortic valve surgery has not been adopted by a significant proportion of cardiac surgeons despite proven benefits. This may be related to a high learning curve and technical issues requiring retraining. In this review, we discuss the data for minimally invasive aortic valve surgery and describe our operative technique for both ministernotomy and anterior thoracotomy approaches. We also discuss the advent of novel sutureless valves and how these techniques compare to available transcatheter aortic valve procedures.

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“…Bedeir et al [17] reported that there was an increased risk of stroke in 57 patients in the femoral cannulation group. Also, aortic dissection, [1] limb ischemia due to low vessel diameter, seroma, pseudoaneurysm, chylothorax or Horner syndrome may be seen due to jugular vein cannulation.…”

Section: Discussionmentioning

confidence: 99%

Atrial septal defect closure via right mini-thoracotomy: Our single center experience

Taşoğlu¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu yazıda santral kanülasyon ve sağ minitorakotomi ile atriyal septal defekt tamiri deneyimimiz sunuldu.Ça lış ma pla nı: Ocak 2013 -Haziran 2016 tarihleri arasında, toplam 148 hastada (93 kadın, 55 erkek; ort. yaş 15.7 yıl; dağılım 1.5-50 yıl) atriyal septal defektler sağ minitorakotomi ile kapatıldı. Sağ minitorakotomi insizyon yerine hastaların yaşı ve cinsiyetine göre karar verildi. Tüm hastalarda santral aortik ve bikaval kanülasyon uygulandı. Cilt insizyonu 13 yaş altı çocuklarda 5±1 cm, 13 yaş üstü çocuklarda 6±1.5 cm ve yetişkinlerde 7.5 cm uzunluğunda idi. Atriyal septal defektler tüm hastalarda sağ minitorakotomi ile başarıyla kapatıldı (3 triküspid yetmezliği, 17 parsiyel anormal pulmoner venöz dönüş anomalisi ve 2 Scimitar sendromu). Bul gu lar:Hiçbir hastada mortalite izlenmedi. Ameliyat sırasında acil sternotomi veya femoral kanülasyon ihtiyacı olmadı. Ortalama kardiyopulmoner baypas süresi 38±8.2 dk. iken, ortalama aortik krosklemp süresi 16±3.8 dk. ve ortalama ameliyat süresi 124±11.3 dk. idi. Ortalama yoğun bakımda kalış süresi 22 saat ve hastane kalış süresi 4 ila 6 gün idi. Dört hastada (%3.25) ekokardiyografide hemodinamik olarak hemodinamik açıdan önemsiz rezidüel atriyal septal defekt saptandı.So nuç: Atriyal septal defektlerin düzeltilmesinde submammaryan insizyon ile birlikte sağ minitorakotominin iyi estetik sonuçlar ile birlikte güvenli ve etkili bir teknik olduğu düşünülmektedir.Anah tar söz cük ler: Atriyal septal defekt; doğuştan kalp hastalığı; estetik; minimal invaziv. ABSTRACTBackground:In this article, we report our experience with repair of atrial septal defects through central cannulation and a right mini-thoracotomy.

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Elevated Stroke Risk Associated With Femoral Artery Cannulation During Mitral Valve Surgery

Cited by 28 publications

References 17 publications

Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

Aortic Valve Surgery: Minimally Invasive Options

Atrial septal defect closure via right mini-thoracotomy: Our single center experience

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