MP08. Central Arterial Cannulation is a Safe and Efficient Alternative in Minimally Invasive Mitral Valve Surgery
Presented During: Moderated E-Posters
New York Presbyterian/Columbia
New York, NY
United States - Contact Me
Riley Sevensky is a medical student at Columbia University Vagelos College of Physicians and Surgeons. She completed her undergraduate education at Johns Hopkins University in 2020, where she studied both Molecular and Cellular Biology as well as Public Health Studies. She then spent a year working in translational research involving neonatal neuroinflammation at the Johns Hopkins Hospital. Riley was awarded an NIH T35 grant to pursue cardiothoracic surgery-related research during the summer of 2022.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective
Peripheral arterial cannulation (PAC) facilitates minimally invasive cardiac surgery (MICS) by allowing safe vascular access despite small chest incisions. However, because PAC may result in peripheral vascular complications, and is contraindicated in certain patients and anatomy, we have developed and frequently used a central arterial cannulation (CAC) technique as an alternative. We report a comparison of these two cannulation strategies in a contemporary cohort at our institution.
Methods
All patients who underwent minimally invasive isolated mitral valve surgery at our institution between 2015 and 2020 were included. Data was compiled from a NYS Cardiac Surgery Reporting System query and supplemented by patient chart and surgical record review. Unpaired two-tailed T-tests and Fischer's exact tests were utilized to determine significance.
Results
Over the specified 5-year period, 519 patients underwent MICS at our institution. In order to allow for meaningful comparison of operative times, we chose to study only patients undergoing isolated mitral valve operations (n = 73). All of these operations were performed via right minithoracotomy, and 29 (39.7%) had CAC and 44 (60.3%) had PAC. Baseline demographics and preoperative risk factors were similar in the two groups, except that preoperative BMI was significantly higher in the PAC group (CAC: 24.4 vs PAC: 26.5, p=0.030). CAC was associated with significantly decreased anesthesia time compared to PAC (370.6 vs. 397.6 min, p=0.031), and this was also true for cardiopulmonary bypass time (109.8 vs. 141.2 min, p=0.0001) and aortic cross-clamp time (74.8 vs. 88.5 min, p=0.010). Hospital length of stay was not different between groups (CAC: 5.8 vs. PAC: 6.3 d, p=0.487). There were no deaths in either group. Regardless of arterial cannulation, all patients had some form of peripheral venous cannulation, and in 10 patients (13.7%), peripheral vascular or lymphatic complications occurred.
Conclusions
In a contemporary cohort of isolated minimally invasive mitral operations, CAC was not only safe, but resulted in significantly reduced anesthesia, bypass, and clamp times when compared to PAC. Therefore, when patient size and chest anatomy permit, CAC is an excellent option, especially in patients with contraindications to PAC, such as small or tortuous vessels, or vascular disease.
Peripheral arterial cannulation (PAC) facilitates minimally invasive cardiac surgery (MICS) by allowing safe vascular access despite small chest incisions. However, because PAC may result in peripheral vascular complications, and is contraindicated in certain patients and anatomy, we have developed and frequently used a central arterial cannulation (CAC) technique as an alternative. We report a comparison of these two cannulation strategies in a contemporary cohort at our institution.
Methods
All patients who underwent minimally invasive isolated mitral valve surgery at our institution between 2015 and 2020 were included. Data was compiled from a NYS Cardiac Surgery Reporting System query and supplemented by patient chart and surgical record review. Unpaired two-tailed T-tests and Fischer's exact tests were utilized to determine significance.
Results
Over the specified 5-year period, 519 patients underwent MICS at our institution. In order to allow for meaningful comparison of operative times, we chose to study only patients undergoing isolated mitral valve operations (n = 73). All of these operations were performed via right minithoracotomy, and 29 (39.7%) had CAC and 44 (60.3%) had PAC. Baseline demographics and preoperative risk factors were similar in the two groups, except that preoperative BMI was significantly higher in the PAC group (CAC: 24.4 vs PAC: 26.5, p=0.030). CAC was associated with significantly decreased anesthesia time compared to PAC (370.6 vs. 397.6 min, p=0.031), and this was also true for cardiopulmonary bypass time (109.8 vs. 141.2 min, p=0.0001) and aortic cross-clamp time (74.8 vs. 88.5 min, p=0.010). Hospital length of stay was not different between groups (CAC: 5.8 vs. PAC: 6.3 d, p=0.487). There were no deaths in either group. Regardless of arterial cannulation, all patients had some form of peripheral venous cannulation, and in 10 patients (13.7%), peripheral vascular or lymphatic complications occurred.
Conclusions
In a contemporary cohort of isolated minimally invasive mitral operations, CAC was not only safe, but resulted in significantly reduced anesthesia, bypass, and clamp times when compared to PAC. Therefore, when patient size and chest anatomy permit, CAC is an excellent option, especially in patients with contraindications to PAC, such as small or tortuous vessels, or vascular disease.