Perfusion and cannulation techniques in minimally invasive thoracic aortic repair

Charchyan E.R.; Breshenkov D.G.; Dzeranova A.N.; Panov A.V.; Belov Yu.V.

doi:https://doi.org/10.17116/kardio20211401171

Charchyan E.R.

Petrovsky National Research Centre of Surgery

SPIN RSCI: 4641-0523
Scopus AuthorID: 14044681400
ORCID: 0000-0002-0488-2560

Breshenkov D.G.

Petrovsky National Research Centre of Surgery

Dzeranova A.N.

Petrovsky Russian Research Center of Surgery

Panov A.V.

Petrovsky Russian Research Center of Surgery

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Perfusion and cannulation techniques in minimally invasive thoracic aortic repair

Authors:

Charchyan E.R., Breshenkov D.G., Dzeranova A.N., Panov A.V., Belov Yu.V.

More about the authors

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(1): 71‑79

DOI: 10.17116/kardio20211401171

Read: 2829 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Charchyan ER, Breshenkov DG, Dzeranova AN, Panov AV, Belov YuV. Perfusion and cannulation techniques in minimally invasive thoracic aortic repair. Russian Journal of Cardiology and Cardiovascular Surgery. 2021;14(1):71‑79. (In Russ.)
https://doi.org/10.17116/kardio20211401171

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To determine the optimal algorithm for choosing a cannulation strategy in minimally invasive thoracic aorta repair and to assess its safety.

MATERIAL AND METHODS

A retrospective cohort analysis included 189 patients with thoracic aortic disease who underwent minimally invasive surgical treatment since 2016. In all patients, the procedure was performed through the upper median J-shaped ministernotomy in the 4^th intercostal space. Bentall-DeBono procedure was performed in 56 cases, David procedure — 45, ascending aorta replacement with aortic valve replacement — 37, ascending aorta replacement with aortic root repair — 36 cases. Aortic arch replacement was performed in 39 patients: total arch replacement — 18 patients, Hemiarch procedure — 21. In all cases, cannulation technique was chosen after preoperative planning based on CT data and personalized algorithm. Central arterial cannulation has been used since October 2019 in patients without enlargement/aneurysm of aortic arch and primary surgery. This approach was applied in 14 cases (7.5%), right axillary artery cannulation — 32 cases (16.9%), femoral artery cannulation — 143 (75.6%) cases. Central venous cannulation was also performed in 14 cases (7.5%), while peripheral venous cannulation was performed in 175 (92.5%) patients. Carpentier two-stage cannula was inserted in case of combined disease of thoracic aorta and mitral valve or right cardiac chambers. Intraoperative features and the effect of different cannulation techniques on postoperative results were analyzed.

RESULTS

Mean age was 44.4±14.5 years. Incidence of conversions to midline sternotomy was 1.6% (n=3) due to the need for urgent myocardial revascularization in patients with peripheral cannulation (p>0.05). There were no cases of intraoperative aortic dissection and neurological complications. Lymphorrhoea within the peripheral approach was observed in 5 cases (2.6%) (p>0.05). In-hospital mortality was 2 cases (1.1%). No significant effect of cannulation technique on major complications and mortality was observed.

CONCLUSION

Currently, there are many options for cannulation in minimally invasive surgery of thoracic aorta. The type of procedure, preoperative planning, and experience of surgical team are the main factors to choose a certain perfusion and cannulation strategy. Thus, personalized algorithm for choosing a cannulation technique in combination with experience of aortic team ensure safe minimally invasive procedures.

Keywords:

minimally invasive cardiac surgery

aneurysm

dissection

thoracic aorta repair

ministernotomy

cannulation

perfusion

Authors:

Charchyan E.R.

Petrovsky National Research Centre of Surgery

SPIN RSCI: 4641-0523
Scopus AuthorID: 14044681400
ORCID: 0000-0002-0488-2560

Breshenkov D.G.

Petrovsky National Research Centre of Surgery

Dzeranova A.N.

Petrovsky Russian Research Center of Surgery

Panov A.V.

Petrovsky Russian Research Center of Surgery

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Received:

11.10.2020

Accepted:

15.11.2020

Close metadata

References:

Rayner TA, Harrison S, Rival P, Mahoney DE, Caputo M, Angelini GD, Savović J, Vohra HA. Minimally invasive versus conventional surgery of the ascending aorta and root: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2020;57(1):8-17. https://doi.org/10.1093/ejcts/ezz177
Harky A, Al-Adhami A, Chan JSK, Wong CHM, Bashir M. Minimally Invasive Versus Conventional Aortic Root Replacement — A Systematic Review and Meta-Analysis. Heart Lung Circ. 2019;28(12):1841-1851. https://doi.org/10.1016/j.hlc.2018.10.023
Chan EY, Lumbao DM, Iribarne A, Easterwood R, Yang JY, Cheema FH, Smith CR, Argenziano M. Evolution of cannulation techniques for minimally invasive cardiac surgery: a 10-year journey. Innovations (Phila). 2012;7(1):9-14. https://doi.org/10.1097/IMI.0b013e318253369a
Lamelas J, Williams RF, Mawad M, LaPietra A. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery. Ann Thorac Surg. 2017;103(6):1927-1932. https://doi.org/10.1016/j.athoracsur.2016.09.098
Grossi EA, Loulmet DF, Schwartz CF, Solomon B, Dellis SL, Culliford AT, Zias E, Galloway AC. Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurologic complications. Ann Thorac Surg. 2011;92(4):1346-1349; discussion 1349-1350. https://doi.org/10.1016/j.athoracsur.2011.04.055
Murzi M, Glauber M. Central versus femoral cannulation during minimally invasive aortic valve replacement. Ann Cardiothorac Surg. 2015;4(1):59-61. https://doi.org/10.3978/j.issn.2225-319X.2014.10.06
Gravlee GP, ed. Cardiopulmonary bypass: principles and practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008;783.
Ramchandani M, Al Jabbari O, Abu Saleh WK, Ramlawi B. Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery. Methodist Debakey Cardiovasc J. 2016;12(1):10-13. https://doi.org/10.14797/mdcj-12-1-10
Franco KL, Vinod HT. Cardiothoracic surgery review. Philadelphia: Lippincott Williams & Wilkins; 2012;1770.
Pozzi M, Henaine R, Grinberg D, Robin J, Saroul C, Delannoy B, Desebbe O, Obadia JF. Total percutaneous femoral vessels cannulation for minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2013;2(6):739-743.
Marasco SF, Tutungi E, Vallance SA, et al. A Phase 1 Study of a Novel Bidirectional Perfusion Cannula in Patients Undergoing Femoral Cannulation for Cardiac Surgery. Innovations (Phila). 2018;13(2):97-103. https://doi.org/10.1097/IMI.0000000000000489
Preventza O, Bakaeen FG, Stephens EH, Trocciola SM, de la Cruz KI, Coselli JS. Innominate artery cannulation: an alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery. J Thorac Cardiovasc Surg. 2013;145(3 Suppl):191-196.
Carino D, Mori M, Pang PYK, Singh M, Elkinany S, Tranquilli M et al. Direct axillary cannulation with open Seldinger-guided technique: is it safe? Eur J Cardiothorac Surg. 2018;53:1279-1281.
El Kerdany A, Abd Al Jawad M. Femoral artery versus right axillary artery cannulation in various cardiac procedures, a single center experience: The quest for the holy grail. Journal of the Egyptian Society of Cardio-Thorac Surg. 2018;26(2):89-94. https://doi.org/10.1016/j.jescts.2018.03.006
Kozlov BN, Panfilov DS, Kuznetsov MS, Ponomarenko IV, Nasrashvili GG, Shipulin VM. Antegrade unilateral perfusion of the brain through the brachiocephalic trunk during operations on the aortic arch. Angiologiya i sosudistaya khirurgiya. 2016;22(1):195-198. (In Russ.).
Shlomin VV, Zverev DA, Zvereva ED, Puzdryak PD, Bondarenko PB, Gordeev ML. A case of successful two-stage surgical treatment of thoracoabdominal aortic aneurysm. Angiologiya i sosudistaya khirurgiya. 2017;23(2):164-168. (In Russ.).
Tungusov DS, Chernov II, Kondratyev DA, Motreva AP, Ekimov SS, Isaev MN, Tarasov DG. Aortic valve replacement through J-Shape mininotomy in a patient with severe chest trauma. Kardiologiya i serdechno-sosudistaya khirurgiya. 2015;8(2):93-95. (In Russ.). https://doi.org/10.17116/kardio20158293-95
De Somer F. Venous drainage — gravity or assisted? Perfusion. 2011;26(Suppl 1):15-19. https://doi.org/10.1177/0267659110394713
Vaughan P, Fenwick N, Kumar P. Assisted venous drainage on cardiopulmonary bypass for minimally invasive aortic valve replacement: is it necessary, useful or desirable? Interact Cardiovasc Thorac Surg. 2010;10(6):868-871. Epub 2010 Mar 15. https://doi.org/10.1510/icvts.2009.230888
Rao PN, Kumar AS. Aortic valve replacement through right thoracotomy. Tex Heart Inst J. 1993;20(4):307-308.
Nakamura Y, Emmanuel S, Shikata F, Shirai C, Ito Y, Kuroda M. Pressure difference between radial and femoral artery pressure in minimally invasive cardiac surgery using retrograde perfusion. Int J Artif Organs. 2018;41(10):635-643. Epub 2018 July 12. https://doi.org/10.1177/0391398818784791
Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010;90(5):1401-1408, 1410.e1; discussion 1408-1410. https://doi.org/10.1016/j.athoracsur.2010.05.055
Bisdas T, Beutel G, Warnecke G, Hoeper MM, Kuehn C, Haverich A, Teebken OE. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg. 2011;92(2):626-631. Epub 2011 May 8. https://doi.org/10.1016/j.athoracsur.2011.02.018
Tarui T, Miyata K, Shigematsu S, Watanabe G. Risk factors to predict leg ischemia in patients undergoing single femoral artery cannulation in minimally invasive cardiac surgery. Perfusion. 2018;33(7):533-537. https://doi.org/10.1177/0267659118768151
Muratov RM, Shamsiev GA, Midinov Ash, Bokeria LA. Obesity and heart valve pathology — mininotomy as a way to reduce the incidence of early postoperative complications. Byulleten’ NTsSSKh im. A.N. Bakuleva RAMN. Serdechno-sosudistye zabolevaniya. 2010;11(S6):23. (In Russ.).