Introduction: Peripheral access cardiopulmonary bypass (CPB) and endoclamping of the aorta are prerequisites for performance of minimal access or totally endoscopic cardiac surgery on the arrested heart. We present our experience with the ESTECH remote access perfusion (RAP) cannula in arrested-heart totally endoscopic coronary bypass grafting (AHTECAB) and atrial-septal defect (ASD) repair via minithoracotomy and totally endoscopic ASD repair.
Patients and methods: Remote access CPB was performed in 30 patients (17 male), with a median age of 56 years (range, 21-70 years) using the ESTECH RAP cannula. Preoperatively all patients received a thoracic and abdominal CT scan. Operations were 20 AHTECAB, 5 ASD repair via minithoracotomy, and 5 robotically assisted totally endoscopic ASD repairs. Intraoperatively the patients were monitored by transesophageal echocardiography and bilateral radial artery pressure lines for correct placement of the balloon in the ascending aorta.
Results: Neither vascular perforation nor dissection of the aorta occurred during these surgeries. Full CPB was achieved in all patients. Because of location in a supraaortic branch fluoroscopic visualization of the guide wire was necessary in 2 of 30 cases. Once the aortic occlusion balloon was placed, repositioning was required in none of our cases. In one AHTECAB case rupture of the balloon occurred before starting the anastomosis. The cannula was replaced and the AHTECAB could be finished without complications. In one patient inguinal wound infection occurred, which was successfully revised surgically. No perioperative myocardial ischemia, stroke, or critical leg ischemia occurred, and no hospital death occurred.
Conclusions: CPB and cardiac arrest can adequately be performed via a femoral access in minimally invasive cardiac surgery using the ESTECH RAP system. Intense preoperative patient evaluation and intraoperative monitoring are absolute prerequisites for safe application of the technique.