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New Research: Percutaneous superior vena cava drainage during minimally invasive mitral valve surgery

Friday, December 12, 2014

J Cardiothorac Vasc Anesth. 2014 Nov 7 [Epub ahead of print]

Percutaneous superior vena cava drainage during minimally invasive mitral valve surgery: a randomized, crossover study.

Bainbridge D, Chu MW, Kiaii B, Cleland A, Murkin J

Abstract

OBJECTIVE:

Minimally invasive techniques commonly are applied to mitral valve surgery; however, there has been little research investigating the optimal methods of cardiopulmonary bypass for the right minithoracotomy approach. Controversy exists as to whether a percutaneous superior vena cava drainage cannula (PSVC) is necessary during these operations. The authors, therefore, sought to determine the effect of using a percutaneous superior vena cava catheter on brain near-infrared spectroscopy, blood lactate levels, hemodynamics and surgical parameters.

DESIGN:

Randomized, blinded, crossover trial.

SETTING:

Tertiary care university hospital.

PARTICIPANTS:

Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy.

INTERVENTIONS:

Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage, during mitral valve repair.

MEASUREMENT AND MAIN RESULTS:

For the primary outcome of brain near-infrared spectroscopy, there were no differences between the two groups (percutaneous superior vena cava clamped 55.0%±11.6% versus unclamped 56.1%±10.2%) (p = 0.283). For the secondary outcomes pH (clamped 7.35±0.05 versus unclamped 7.37±0.05 p = 0.015), surgical score (clamped 1.96±1.14 versus unclamped 1.22±0.51 p = 0.002) and CVP (clamped 11.6 mmHg±4.8 mmHg versus unclamped 6.1 mmHg±6.1 mmHg p<0.001) were significantly different.

CONCLUSIONS:

The use of a percutaneous superior vena cava drainage improved surgical visualization and lowered CVP, but had no effect on brain near infrared spectroscopy during minimally invasive mitral valve surgery. (ClinicalTrials.gov Identifier: NCT01166841).

Check out the article on PubMed