Tarui Tatsuya, Miyata Kazuto, Shigematsu Sayaka, Watanabe Go
1 Department of Cardiovascular Surgery, NewHeart Watanabe Institute, Tokyo, Japan.
2 Department of Anesthesia, NewHeart Watanabe Institute, Tokyo, Japan.
Perfusion. 2018 Oct;33(7):533-537. doi: 10.1177/0267659118768151. Epub 2018 Apr 11.
In peripheral cannulation for cardiopulmonary bypass, there is always a risk of ischemia in the extremities, caused by femoral artery cannulation. This report aimed to evaluate the outcome and the risk factors in patients undergoing minimally invasive cardiac surgery in mitral valve surgery.
We retrospectively reviewed all minimally invasive mitral valve surgery at our institute from May 2014 to December 2016. Operative outcomes and intra-operative monitoring for distal leg saturation were measured by the near-infrared spectroscopy values. For post-operative outcomes, the creatinine phosphorus kinase level was measured for the assessment of leg ischemia. Risk factors were evaluated for the elevation of post-operative creatinine phosphorus kinase.
There were 162 patients who underwent single femoral artery cannulation for minimally invasive mitral valve surgery. The mean operation, cardiopulmonary bypass and aortic cross-clamp time were 212±44, 124±30, 76.6±22 minutes (min), respectively. The factors related to increased creatinine phosphorus kinase were male, body mass index, larger cannula size, operation time, cardiopulmonary bypass time and aortic cross-clamp time. The measurement of minimum near-infrared spectroscopy values did not show any association with creatinine phosphorus kinase elevation. There were significant associations between body mass index, cannula size and operation time and post-operative creatinine phosphorus kinase increase by multiple regression analysis. Two male patients had extremely high post-operative creatinine phosphorus kinase (18188 U/L and 16831 U/L) and they had high body mass index, large cannula size and longer operation time.
In peripheral cannulation for minimally invasive cardiac surgery, body mass index, cannula size and operation time can be considered as risk factors for leg ischemia.
在体外循环的外周插管中，股动脉插管总是存在导致肢体缺血的风险。本报告旨在评估二尖瓣手术中接受微创心脏手术患者的结局及危险因素。
我们回顾性分析了2014年5月至2016年12月在我院接受的所有微创二尖瓣手术。通过近红外光谱值测量手术结局及术中下肢远端饱和度监测情况。对于术后结局，测量肌酸磷酸激酶水平以评估腿部缺血情况。评估术后肌酸磷酸激酶升高的危险因素。
有162例患者接受了单股动脉插管的微创二尖瓣手术。平均手术时间、体外循环时间和主动脉阻断时间分别为212±44、124±30、76.6±22分钟（min）。与肌酸磷酸激酶升高相关的因素有男性、体重指数、较大的插管尺寸、手术时间、体外循环时间和主动脉阻断时间。最低近红外光谱值的测量与肌酸磷酸激酶升高无任何关联。通过多元回归分析，体重指数、插管尺寸和手术时间与术后肌酸磷酸激酶升高之间存在显著关联。两名男性患者术后肌酸磷酸激酶极高（分别为18188 U/L和16831 U/L），他们体重指数高、插管尺寸大且手术时间长。
在微创心脏手术的外周插管中，体重指数、插管尺寸和手术时间可被视为腿部缺血的危险因素。
