Ma Kristina, Kastengren Mikael, Svenarud Peter, Green Ram, Dalén Magnus
Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Eur J Cardiothorac Surg. 2023 Mar 1;63(3). doi: 10.1093/ejcts/ezad020.
Large series of percutaneous femoral access for extracorporeal circulation in minimally invasive cardiac surgery (MICS) are scarcely reported.
This is a single-centre study describing the use of percutaneous femoral access in patients undergoing MICS via minithoracotomy. Femoral artery closure was performed with a plug-based closure device. To reduce the risk for vascular complications, intraoperative ultrasound assessment of correct deployment of the arterial closure device was done during the later period of the study.
During a 5-year period, 650 patients underwent percutaneous femoral cannulation and decannulation with device closure of the femoral artery puncture. Two hundred and seven patients (31.8%) were operated in the early phase of the experience (August 2017-August 2019), without the use of intraoperative ultrasound assessment of closure device deployment. During the later period of our experience (August 2019-September 2022), 443 patients (68.2%) were operated, of whom all underwent intraoperative ultrasound assessment of closure device deployment. Of the patients operated without intraoperative ultrasound assessment, 6 patients (2.9%) experienced vascular complications compared with none of the patients in whom intraoperative ultrasound-assessment was used (P < 0.001). In total, 15 patients (2.3%) underwent conversion to surgical cutdown owing to incomplete haemostasis or femoral artery stenosis/occlusion and the mechanism was intravascular deployment of the closure device in all 15 cases.
Percutaneous femoral access in MICS is safe and the need for surgical cutdown was infrequent. The risk for vascular complications is minimized with the use of intraoperative ultrasound assessment of the correct positioning of the vascular closure device.
http://www.clinicaltrials.gov; Unique identifier: NCT05462769.
关于微创心脏手术（MICS）中经皮股动脉入路用于体外循环的大型系列报道鲜有。
这是一项单中心研究，描述了经小切口开胸行MICS患者使用经皮股动脉入路的情况。采用基于封堵器的封堵装置进行股动脉闭合。为降低血管并发症风险，在研究后期对动脉封堵装置的正确放置进行术中超声评估。
在5年期间，650例患者接受了经皮股动脉插管及拔管，并使用装置闭合股动脉穿刺口。207例患者（31.8%）在经验早期（2017年8月至2019年8月）接受手术，未使用术中超声评估封堵装置的放置情况。在经验后期（2019年8月至2022年9月），443例患者（68.2%）接受手术，所有患者均接受了术中超声评估封堵装置的放置情况。在未进行术中超声评估的手术患者中，6例（2.9%）发生血管并发症，而使用术中超声评估的患者中无一例发生（P＜0.001）。总共15例患者（2.3%）因止血不完全或股动脉狭窄/闭塞而改行手术切开，所有15例的机制均为封堵装置在血管内的放置。
MICS中经皮股动脉入路是安全的，手术切开的需求很少。通过术中超声评估血管封堵装置的正确定位可将血管并发症风险降至最低。
