Perfusion and cannulation techniques in minimally invasive thoracic aortic repair

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.

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

DOI: 10.17116/kardio20211401171

Downloaded: 117

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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 2025-2 (Russian Journal of Cardiology and Cardiovascular Surgery)

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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

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