J Extra Corpor Technol 2025 , 57 , 32 – 37 Ó The Author ( s ), published by EDP Sciences , 2025 https :// doi . org / 10.1051 / ject / 2024036
Available online at : ject . edpsciences . org
CASE REPORT
Assistance from a mixing zone model to perform aortic femoral perfusion strategy with severe atherosclerotic and artheromic aortic disease for endoscopic minimally invasive redo mitral valve repair
Tomohisa Takeichi ( CE ) 1 ,* , Yoshihisa Morimoto ( MD ) 2 , Akitoshi Yamada ( MD ) 2 , Takanori Tanaka ( CE ) 1 , Kunihiro Fujiwara ( CE ) 1 , Masanobu Sato ( MD ) 2 , Ryo Toma ( MD ) 2 , Kiyoto Mitsui ( CE ) 1 , Takumi Sugita ( CE ) 1 , Hiroki Yamada ( CE ) 1 , Kanako Nakagaki ( CE ) 1 , Hiroto Kuriyama ( CE ) 1 , and Kunio Gan ( MD ) 2
1 Department of Clinical Engineering , Kitaharima Medical Center , 926-250 , Ichiba-cho , Ono-shi , Hyogo , 675-1392 , Hyogo , Japan 2 Cardiovascular Surgery , Kitaharima Medical Center , 926-250 , Ichiba-cho , Ono-shi , Hyogo , 675-1392 , Hyogo , Japan
Received 19 June 2024 , Accepted 22 November 2024
Abstract – Minimally invasive cardiac surgery ( MICS ) for redo mitral valve surgery in the presence of severe atheroma and atherosclerotic diseased atherosclerotic and artheromic aorta presents significant challenges and increases the risk of postoperative cerebral infarction . At our institution , to mitigate the risk of postoperative cerebral complications , we employ a strategy combining antegrade and retrograde perfusion during MICS for patients with atherosclerotic and artheromic aorta . However , the mixing zone during cardiopulmonary bypass ( CPB ) with combined antegrade and retrograde perfusion has not been thoroughly evaluated . In this case , we performed a completely endoscopic MICS redo mitral valve plasty ( MVP ). CPB was established using cannulation of both the ascending aorta ( Asc Ao ) and the femoral artery ( FA ). The patient received planned systemic hyperkalemia without an aortic cross clamp . In addition , due to aortic insufficiency , circulatory arrest was also needed . The patient experienced an uneventful post-operative recovery without any cerebral complication . Furthermore , we evaluated the mixing zone during the combined antegrade and retrograde perfusion using an arteriovenous circulation model . Our findings suggest that when performing perfusion via the Asc Ao and FA , it is advisable to select Asc Ao cannulation size reduced by one size against FA cannulation size to optimize the procedure .
Key words : Cardiopulmonary bypass ( CPB ), Atherosclerotic and artheromic , Mixing zone , Minimally invasive cardiac surgery .
Introduction
In a recent study , minimally invasive cardiac surgery ( MICS ) offers distinct advantages in redo cases when compared to median sternotomy [ 1 ]. Cardiopulmonary bypass ( CPB ) is typically established via femoral artery ( FA ) cannulation in the minithoracotomy approach [ 2 , 3 ]. However , retrograde perfusion is associated with a higher incidence of postoperative neurological complications compared to antegrade perfusion [ 4 – 6 ]. To mitigate the risk of postoperative cerebral complications , particularly in patients with a severe atherosclerotic and atheromic diseased , CPB is established through axillary or ascending aorta ( Asc Ao ) cannulation according to the facility ’ s protocol [ 7 ].
* Corresponding author : tommo . tommo @ outlook . jp
At our institution , in-patients presenting with a severe atherosclerotic and atheromic diseased , we utilize a combination of Asc Ao or axillary artery and FA perfusion . The criteria for this approach include any of the following findings on a preoperative enhanced computed tomography ( CT ) scan of the aorta or iliac arteries : thrombosis with a thickness greater than 4.0 mm or circumferential calcification . Based on these criteria , we employed a combination of Asc Ao and FA perfusion . Additionally , we evaluated the mixing zone when antegrade and retrograde perfusion were combined using an arteriovenous circulation system [ 8 ].
This study was approved by the Institutional Review Board of Kitaharima Medical Center ( IRB 06-16 ), with a waiver of informed consent .
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https :// creativecommons . org / licenses / by / 4.0 ), which permits unrestricted use , distribution , and reproduction in any medium , provided the original work is properly cited .