Department of Cardiovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.
Chin Med J (Engl). 2012 Sep;125(18):3236-9.
Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve. Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery. However, few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery. The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.
We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011, which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp. TEE was used to guide cannulation of the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.
One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB. There were 67 female (51.9%) and 62 male (48.1%) patients, ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m(2) (mean (1.71 ± 0.20) m(2)). Some 61 (47.3%) patients underwent mitral valve repair, 27 (20.9%) mitral valve replacement, 27 (20.9%) left atrial myxoma removal, and 14 (10.9%) ventricular septal defect repair. Of the 129 patients, TEE guided cannulation of the IVC or SVC was successful in all patients (100%), and no puncture related complications occurred in all patients. Of the 129 patients, successful cannulation of the AAO was achieved in all patients (100%), and aortic perforation occurred in 1 patient (0.78%) under TEE guidance. Of the 42 patients in the historical control group, successful cannulation occurred in 39 patients (92.86%), and major complications occurred in 3 patients (7.14%) under fluoroscopy guidance. TEE guided cannulation of the AAO significantly improved success rate (100% vs. 92.86%, P = 0.014) and decreased complication rate (0.78% vs. 7.14%, P = 0.046).
TEE may be useful in guiding successful placement of the cannulae in the IVC, SVC, and AAO in the establishment of peripheral CPB during robotic cardiac surgery.
微创心脏手术和闭合式体外循环（CPB）技术不断发展。之前的报告表明，在经端口心脏手术中，血管内 CPB 的荧光透视引导插管具有优势。然而，在机器人心脏手术中，经食管超声心动图（TEE）引导外周 CPB 插管的作用的数据较少。本研究旨在评估机器人心脏手术中 TEE 引导外周 CPB 插管的效果。
我们对 2007 年 9 月至 2011 年 8 月期间 129 例连续接受机器人心脏手术并需要外周 CPB 的患者的术中数据进行了回顾性分析，CPB 通过股动脉入路和股静脉及右颈内静脉的动力静脉引流建立，经胸主动脉阻断钳阻断升主动脉。TEE 用于引导下腔静脉（IVC）、上腔静脉（SVC）和升主动脉（AAO）的插管。评估并比较 TEE 引导外周 CPB 插管的成功率和并发症发生率，与历史对照组中荧光透视引导插管的结果进行比较。
129 例连续接受机器人心脏手术并需要外周 CPB 的患者中，67 例为女性（51.9%），62 例为男性（48.1%），年龄 13-70 岁（平均（43.94±13.82）岁），体表面积 1.32-2.39m2（平均（1.71±0.20）m2）。61 例（47.3%）患者行二尖瓣修复术，27 例（20.9%）行二尖瓣置换术，27 例（20.9%）行左心房黏液瘤切除术，14 例（10.9%）行室间隔缺损修补术。129 例患者中，所有患者均成功进行了 TEE 引导下的 IVC 或 SVC 插管（100%），所有患者均未发生与穿刺相关的并发症。129 例患者中，所有患者均成功进行了 TEE 引导下的 AAO 插管（100%），1 例（0.78%）患者发生主动脉穿孔。在历史对照组的 42 例患者中，39 例（92.86%）患者插管成功，3 例（7.14%）患者在荧光透视引导下发生严重并发症。TEE 引导的 AAO 插管可显著提高成功率（100% vs. 92.86%，P=0.014）和降低并发症发生率（0.78% vs. 7.14%，P=0.046）。
TEE 可用于指导机器人心脏手术中经外周 CPB 建立时 IVC、SVC 和 AAO 插管的成功放置。
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