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J Thorac Cardiovasc Surg 2007;133:1066-1070
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Avoiding vascular complications during minimally invasive, totally endoscopic intracardiac surgery

Hugues Jeanmart, MDa, Filip P. Casselman, MD, PhDa,*, Yuan De Grieck, MDa, Ihsan Bakir, MDa, Jose Coddens, MDb, Luc Foubert, MDb, Geert Van Vaerenbergh, MDa, Yvette Vermeulen, MSca, Hugo Vanermen, MDa,1

a Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
b Department of Anesthesiology, OLV Clinic, Aalst, Belgium.

Received for publication March 19, 2006; revisions received October 9, 2006; accepted for publication December 4, 2006.

* Address for reprints: F. P. Casselman, MD, PhD, FETCS, OLV Clinic—Department of Cardiovascular and Thoracic Surgery, Moorselbaan 164, Aalst, B-9300, Belgium. (Email: filip.casselman{at}olvz-aalst.be).

Objective: The introduction of minimally invasive valve surgery has been associated with an increased use of peripheral vessel cannulation in cardiopulmonary bypass. These techniques are associated with potential problems at the aorta or cannulation sites. The goal of this study was to review and describe our current practice to avoid vascular problems during cannulation of peripheral vessels.

Method: Data collection for this study was done retrospectively by reviewing the files of all patients who underwent a minimally invasive mitral and/or tricuspid surgery in our institution from 1997 to the end of 2005.

Results: Our cohort of 978 patients revealed an overall rate of peripheral vascular complication of 1.0% with 44.4% presenting at the time of the surgery and 63.6% at long-term follow-up. Acute peripheral vascular problems were treated by simple graft replacement of the diseased segment in most cases. All aortic complications happened at the time of the surgery (complication rate of 0.9%) with 60% of them associated with cannulation problems. Most patients were treated by replacement of the ascending aorta.

Conclusions: A systematic and careful approach is associated with a low risk of vascular problems. Prevention and planning with precise surgical technique remain the main conditions to safely use peripheral cannulation and perfusion for minimally invasive mitral valve surgery.

Abbreviations and Acronyms MRI = magnetic resonance imaging






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