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

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).

Keywords: anesthesia; cardiac surgery, mitral valve surgery; cardiopulmonary bypass; minimally invasive surgery; superior vena cava drainage; transesophageal echocardiography.