Department of Cardiac Surgery, "Cardiothoracic Hospital Louis Pradel", Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France; ; Ph.D. School in Cardiovascular Science, Cardiovascular Surgery Unit, University of Verona Medical School, Verona, Italy;
Department of Cardiac Surgery, "Cardiothoracic Hospital Louis Pradel", Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France;
Ann Cardiothorac Surg. 2013 Nov;2(6):739-43. doi: 10.3978/j.issn.2225-319X.2013.08.02.
Minimally invasive mitral valve surgery (MIMVS) has experienced several technological changes in the last two decades. Our aim was to describe one of the most recent improvements, the utilization of a total percutaneous femoral vessels cannulation technique during MIMVS.
We performed a retrospective observational analysis of this technique among 300 consecutive MIMVS patients, with particular focus on cannulation aspects of MIMVS, its success rate and potential complications.
From October 2008 to December 2012, 300 patients (60% males) were operated on. Mean age was 62.9±16.4 years. Indications for operation included mitral valve repair (93%) and mitral valve replacement (7%). Two femoral arterial catheterizations failed and required conversion to sternotomy. The complications on the arterial side were: 5 (1.6%) cases of bleeding during the introduction of Prostar leading to a preoperative surgical hemostasis; 2 (0.6%) retroperitoneal bleeds during cardiopulmonary bypass requiring difficult surgical control but with an uneventful follow-up; 6 (2%) bleeding episodes after removal of the arterial cannula easily controlled by direct surgical revision; 1 (0.3%) arterio-venous fistula requiring a surgical correction on postoperative day 32; 1 (0.3%) patient had a transitory claudication due to a superficial femoral artery thrombosis progressively compensated by the collateral circulation. There were no postoperative bleeding complications. There were no other complications linked to the femoral cannulations or to the groin occurred during the follow-up. The percentage of uneventful arterial cannulations was 80% among the first 50 patients (N=10 out of 50) and 98.8% thereafter (N=3 out of 250).
Total percutaneous femoral vessels cannulation technique is particularly suitable for MIMVS with a high success rate and few complications after a short learning curve. With the advent of the percutaneous approach, the traditional complications of the groin incision have completely disappeared in modern operations with no groin infection, hematoma or lymphocele.
微创二尖瓣手术（MIMVS）在过去二十年中经历了几次技术变革。我们的目的是描述其中最新的一项改进，即在 MIMVS 中使用完全经皮股血管插管技术。
我们对 300 例连续 MIMVS 患者进行了这项技术的回顾性观察分析，特别关注 MIMVS 的插管方面、成功率和潜在并发症。
2008 年 10 月至 2012 年 12 月，300 例患者（60%为男性）接受了手术。平均年龄为 62.9±16.4 岁。手术指征包括二尖瓣修复（93%）和二尖瓣置换（7%）。有 2 例股动脉插管失败，需要改为胸骨切开术。动脉侧的并发症包括：5 例（1.6%）在导丝 Prostar 插入时发生出血，导致术前手术止血；2 例（0.6%）在体外循环期间腹膜后出血，需要困难的手术控制，但随访无异常；6 例（2%）动脉插管拔除后出血，容易通过直接手术修正控制；1 例（0.3%）动静脉瘘，需要在术后第 32 天进行手术矫正；1 例（0.3%）患者因股浅动脉血栓形成出现短暂跛行，由侧支循环逐渐代偿。术后无出血并发症。随访期间未发生与股部插管或腹股沟相关的其他并发症。在前 50 例患者（N=10）中，无并发症的动脉插管率为 80%，而在后 250 例患者中为 98.8%（N=3）。
完全经皮股血管插管技术特别适合 MIMVS，成功率高，学习曲线短，并发症少。随着经皮入路的出现，传统的腹股沟切口并发症在现代手术中已完全消失，腹股沟无感染、血肿或淋巴囊肿。
