Background
The relationship between retrograde arterial perfusion and stroke in patients with
peripheral vascular disease has been widely documented. Antegrade arterial perfusion
has been favoured as an alternative approach in less invasive mitral valve (MV) operations.
We aimed to analyse our experience in patients with peripheral arterial disease undergoing
MV surgery through a right mini-thoracotomy adopting antegrade arterial perfusion.
Method
A single-institution retrospective study on prospectively collected data was performed
on patients undergoing right mini-thoracotomy MV surgery with antegrade arterial perfusion.
Since 2009, indication for the latter was dictated by the severity of atherosclerotic
burden. Preoperative screening included computed tomography, angiography, or both
for the evaluation of the aorta and ileo-femoral arteries.
Results
Consecutive patients (n=117) underwent MV surgery through a right mini-thoracotomy
with antegrade arterial perfusion, established either by transthoracic central aortic
cannulation in 65 (55.6%) cases or by axillary arterial cannulation in 52 (44.4%).
Mean logistic EuroSCORE was 11%±2.3%. Twenty-five (25) (21.4%) patients had undergone
one or more previous cardiac operations. Operative mortality was 4.3% (n=5). Nonfatal
iatrogenic aortic dissection occurred in one case (0.8%). The incidence of stroke
was zero.
Conclusions
Axillary or central aortic cannulation is a promising alternative route to provide
excellent arterial perfusion in right mini-thoracotomy MV surgery, with a very low
incidence of stroke and other major perioperative complications in patients with severe
aortic or peripheral arterial disease.
Keywords
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Article info
Publication history
Published online: September 13, 2021
Accepted:
August 12,
2021
Received in revised form:
June 21,
2021
Received:
February 18,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
