Kitahara Hiroto, Okamoto Kazuma, Kudo Mikihiko, Yoshitake Akihiro, Ito Takahito, Hayashi Kanako, Inaba Yu, Akamatsu Yuta, Shimizu Hideyuki
Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Gen Thorac Cardiovasc Surg. 2016 Mar;64(3):131-7. doi: 10.1007/s11748-015-0611-2. Epub 2015 Dec 8.
In cases of cardiac surgery via a minimally invasive right minithoracotomy approach, cardiopulmonary bypass is established with peripheral arterial cannulation, frequently with a single femoral artery. Occasionally, alternative perfusion access is required to prevent perfusion site-related complications. In this study, the feasibility of alternative perfusion strategies was verified by comparing the postoperative outcomes and complications.
The records of 91 consecutive patients (68 women, 23 men; mean age 40.7 ± 16.5 years) who underwent atrial septal defect (ASD) closure via a right minithoracotomy approach between January 2009 and September 2014 were reviewed. Patients were divided into two groups: those with single femoral arterial access (SF group, n = 84), and those with alternative perfusion access (ALT group, n = 7, bilateral femoral arterial cannulation in 6, side-arm graft anastomosed to the femoral artery in 1).
Femoral artery diameter was smaller in the ALT group than in the SF group (6.5 ± 0.5 vs. 7.3 ± 1.0 mm, P = 0.013). Operating time was longer in the ALT group than in the SF group (259.2 ± 54.0 vs. 208.3 ± 54.9 min, P = 0.031). One patient was converted to ascending aortic cannulation owing to high perfusion pressure. Postoperative major cardiac or cerebrovascular events, such as death, stroke, or myocardial infarction, did not occur in either group.
Alternative perfusion access was safe in ASD closure via a right minithoracotomy approach. Precise preoperative evaluation of the iliofemoral artery is important for choosing the appropriate perfusion strategy.
在采用微创右胸小切口入路进行心脏手术的病例中，通过外周动脉插管建立体外循环，通常使用单根股动脉。偶尔，需要采用替代灌注通路以预防与灌注部位相关的并发症。在本研究中，通过比较术后结果和并发症来验证替代灌注策略的可行性。
回顾了2009年1月至2014年9月期间91例连续接受右胸小切口入路房间隔缺损（ASD）封堵术的患者（68例女性，23例男性；平均年龄40.7±16.5岁）的记录。患者分为两组：单根股动脉入路组（SF组，n = 84）和替代灌注入路组（ALT组，n = 7，6例为双侧股动脉插管，1例为侧臂移植物吻合至股动脉）。
ALT组的股动脉直径小于SF组（6.5±0.5 vs. 7.3±1.0 mm，P = 0.013）。ALT组的手术时间长于SF组（259.2±54.0 vs. 208.3±54.9分钟，P = 0.031）。1例患者因灌注压力高而改为升主动脉插管。两组均未发生术后严重心脏或脑血管事件，如死亡、中风或心肌梗死。
在右胸小切口入路ASD封堵术中，替代灌注入路是安全的。术前对髂股动脉进行精确评估对于选择合适的灌注策略很重要。
