Document Detail


Peripheral cardiopulmonary bypass with modified assisted venous drainage and transthoracic aortic crossclamp: optimal management for robotic mitral valve repair.
MedLine Citation:
PMID:  14604249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to evaluate peripheral cardiopulmonary bypass (CPB) with modified assisted venous drainage (MAVD) and transthoracic aortic cross-clamping to maintain a bloodless surgical field, adequate myocardial protection, systemic flow and pressure during robotic surgical repair of the mitral valve. Peripheral CPB was established with a standard Duraflo-coated closed circuit with femoral arterial and venous cannulation. An additional 17 Fr wire-bound cannula was inserted into the right internal jugular vein and drainage rates of 200-400 mL/min were regulated using a separate roller-head pump. A transthoracic aortic crossclamp with antegrade cardioplegia was used for myocardial protection. Mitral valve (MV) repair was then performed through two 1-cm ports for the robotic arms and a 4-cm intercostal incision for the camera and passing suture. From October 2001 to October 2002, 25 patients underwent robotic MV repair. Average surgical times include leaflet resection and repair, 20 min, and insertion of annuloplasty ring, 28 min; average perfusion times, crossclamp 88 min and total bypass time of 126 min. There were no incisional conversions, no reoperations for bleeding and no deaths, strokes or perioperative myocardial infarctions. Twenty-one (84%) patients were extubated in the operating room. Average LOS was 2.7 days with eight (32%) patients discharged home in less than 24 hours. In conclusion, peripheral CPB with gravity drainage of the lower body and MAVD of the upper body allow safe and effective support during robotically assisted minimally invasive MV repair. This approach may be applied to other forms of minimally invasive cardiac surgery that requires CPB.
Authors:
Michael A Sobieski; Mark S Slaughter; David E Hart; Patroklos S Pappas; Antone J Tatooles
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Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase II; Journal Article; Multicenter Study    
Journal Detail:
Title:  Perfusion     Volume:  18     ISSN:  0267-6591     ISO Abbreviation:  Perfusion     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-11-07     Completed Date:  2004-07-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  England    
Other Details:
Languages:  eng     Pagination:  307-11     Citation Subset:  IM    
Affiliation:
Division of Cardiac Surgery, Christ Hospital and Medical Center, Oak Lawn, IL, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures / methods,  standards
Cardiopulmonary Bypass / methods*
Drainage / methods*
Equipment Design
Female
Humans
Length of Stay
Male
Middle Aged
Mitral Valve / surgery*
Postoperative Complications
Robotics*
Surgical Instruments
Time

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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