title: Preoperative vascular imaging for predicting intraoperative modification of peripheral arterial cannulation during minimally invasive mitral valve surgery.
abstract: OBJECTIVE
  Minimally invasive mitral valve surgery using peripheral cannulation for cardiopulmonary bypass (CBP) is increasingly prevalent. Although conceptually straightforward, peripheral CBP involves challenges and risks specific to this method of perfusion. The utility of preoperative vascular imaging in predicting these technical challenges and preventing vascular complications was studied.
  
  
  METHODS
  We performed a retrospective analysis of 73 consecutive patients undergoing minimally invasive mitral valve surgery using femorofemoral CBP with intraluminal aortic occlusion balloon catheter. All patients underwent preoperative computed tomography angiogram or magnetic resonance angiography to study the iliofemoral axes.
  
  
  RESULTS
  None of the patients operated with this technique was found to have arterial stenoses. Patients with a femoral artery diameter of less than 7.3 mm needed bilateral or side-graft arterial cannulation significantly more frequently than patients with larger femoral arteries (46.2% vs 9.1%, P = 0.001). There was a trend toward more frequent modification of arterial cannulation strategy in patients with body surface area less than 1.7 m compared with larger patients (body surface area, 1.7-2.0) (26.3% vs 8.3%, P = 0.07). Patients needing high CBP flow rate (>5 L/min) were no more likely to need dual arterial cannulation (18.2% vs 19.1%, P = 0.68). No patient experienced a vascular complication.
  
  
  CONCLUSIONS
  This preliminary study suggests that preoperative vascular imaging and patient evaluation may predict difficulties with femoral cannulation and perfusion, which can lead to better preoperative planning and potentially prevent vascular complications. Further data will be accumulated and analyzed to confirm these findings.
authors.affiliation: From the *Department of Cardiac Surgery, Hôpital Sacré-Coeur de Montréal, and Departments of †Cardiac Surgery, and ‡Anesthesia, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada.
authors.forename: Cristian
authors.initials: C
authors.lastname: Rosu
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.forename: Jean-Sebastien
authors.initials: JS
authors.lastname: Lebon
authors.forename: Hugues
authors.initials: H
authors.lastname: Jeanmart
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D021721:Balloon Occlusion / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods