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Title: | Incidence, predictors and vascular sequelae of distal limb ischemia in minimally invasive cardiac surgery with femoral artery cannulation: an observational cohort study | Authors: | Ceulemans, Angelique Derwael, Ruben VANDENBRANDE, Jeroen Buyck, Katelijne Gruyters, Ine Van Tornout, Michiel Murkin, John M. Starinieri, Pascal Yilmaz, Alaaddin STESSEL, Bjorn |
Issue Date: | 2023 | Publisher: | SPRINGER | Source: | HEART AND VESSELS, 38 (7) , p. 964-974 | Abstract: | Literature regarding monitoring and consequences of distal limb ischemia due to femoral artery cannulation for Minimally Invasive Cardiac Surgery (MICS) remains limited. The primary objective was to determine its incidence, defined as a >= 15% difference in regional Oxygen Saturation (rSO(2)) lasting >= four consecutive minutes between the cannulated and non-cannulated limb. The secondary objectives included: determination of distal limb ischemia, defined as a Tissue Oxygenation Index (TOI) < 50% in the cannulated limb, identification of predictors for distal limb ischemia, determination of a possible association of NIRS-diagnosed ischemia with acute kidney injury, and the need for vascular surgery up to six months after cardiac surgery. A prospective, observational cohort study with blinded rSO(2)-measurements to prevent intraoperative clinical decision-making. A single-center, community-hospital, clinical study. All consecutive patients >= 18 years old, and scheduled for predefined MICS. Patients underwent MICS with bilateral calf muscle rSO(2)-measurements conducted by Near-Infrared Spectroscopy (NIRS). In total 75/280 patients (26.79%) experienced distal limb ischemia according to the primary objective, while 18/280 patients (6.42%) experienced distal limb ischemia according to the secondary objective. Multivariate logistic regression showed younger age to be an independent predictor for distal limb ischemia (p = 0.003). None of the patients who suffered intraoperative ischemia required vascular surgery within the follow-up period. The incidence of NIRS-diagnosed ischemia varied from 6.4% to 26.8% depending on the used criteria. Short and long-term vascular sequelae, however, are limited and not intraoperative ischemia related. The added value of intraoperative distal limb NIRS monitoring for vascular reasons seems limited. Future research on femoral artery cannulation in MICS should shift focus to other outcome parameters such as acute kidney injury, postoperative pain or paresthesias. | Notes: | Vandenbrande, J (corresponding author), Jessa Hosp, Dept Anesthesiol & Crit Care, Stadsomvaart 11, B-3500 Hasselt, Belgium. Angelique.ceulemans@hotmail.com; Jeroen.vandenbrande@jessazh.be |
Keywords: | Distal limb ischemia;Minimally invasive cardiac surgery;Femoral artery cannulation near-infrared spectroscopy;Cardiopulmonary bypass | Document URI: | http://hdl.handle.net/1942/39747 | ISSN: | 0910-8327 | e-ISSN: | 1615-2573 | DOI: | 10.1007/s00380-023-02241-0 | ISI #: | 000923982900001 | Rights: | The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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