title: 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.
  
  
  METHODS
  Randomized, blinded, crossover trial.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy.
  
  
  METHODS
  Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage, during mitral valve repair.
  
  
  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).
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario Canada. Electronic address: Daniel.bainbridge@lhsc.on.ca.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Bainbridge
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London, Ontario Canada.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London, Ontario Canada.
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.affiliation: Department of Perfusion Services, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cleland
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario Canada.
authors.forename: John
authors.initials: J
authors.lastname: Murkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004322:Drainage / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000592:standards; D008943:Mitral Valve / Q000601:surgery*; D016037:Single-Blind Method; D014683:Vena Cava, Superior / Q000601:surgery*
keywords: anesthesia; cardiac surgery, mitral valve surgery; cardiopulmonary bypass; minimally invasive surgery; superior vena cava drainage; transesophageal echocardiography