Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
Department of Radiology, BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Germany.
J Cardiothorac Surg. 2021 Mar 20;16(1):34. doi: 10.1186/s13019-021-01400-6.
Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department.
Between July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups.
In patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications.
CT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.
股动脉插管体外循环（ECC）是微创心脏手术（MICS）房室瓣的标准程序。血管病变可能会导致严重的并发症。我们科室实施了主动脉、腋动脉和髂动脉的术前计算机断层血管造影（CT-A）。
回顾性分析 2017 年 7 月至 2018 年 12 月所有 MICS（n=143），分为 3 组。
在没有 CT 的患者（n=45，31.5%）中，ECC 通过股动脉进行（91.1%右侧，8.9%左侧）。3 名患者（6.7%）出现血管相关并发症（夹层、中风、冠状动脉和内脏缺血、相关院内死亡）。在非对比 CT 患者（n=35，24.5%）中，仅进行股动脉插管（94.3%右侧），4 名患者（11.4%）发生并发症。CT 血管造影（n=63，44.1%）发现 12 名患者（19.0%）有易损斑块，7 名患者（11.1%）有髂血管扭曲，41 名患者（65.1%）有多个钙化斑块，5 名患者（7.9%）有股动脉直径较小（d≤6mm）。7 名患者（11.1%）的病理发现导致经右侧腋动脉进行替代插管，另外 4 名患者（6.3%）经左侧股动脉插管。仅 2 名患者（3.2%）出现并发症。
CT-A 可识别常规术前准备无法发现的血管病变。标准化的成像方案可能有助于定制手术策略。
