title: Alternative peripheral perfusion strategies for safe cardiopulmonary bypass in atrial septal defect closure via a right minithoracotomy approach.
abstract: OBJECTIVE
  In cases of cardiac surgery via a minimally invasive right minithoracotomy approach, cardiopulmonary bypass is established with peripheral arterial cannulation, frequently with a single femoral artery. Occasionally, alternative perfusion access is required to prevent perfusion site-related complications. In this study, the feasibility of alternative perfusion strategies was verified by comparing the postoperative outcomes and complications.
  
  
  METHODS
  The records of 91 consecutive patients (68 women, 23 men; mean age 40.7 ± 16.5 years) who underwent atrial septal defect (ASD) closure via a right minithoracotomy approach between January 2009 and September 2014 were reviewed. Patients were divided into two groups: those with single femoral arterial access (SF group, n = 84), and those with alternative perfusion access (ALT group, n = 7, bilateral femoral arterial cannulation in 6, side-arm graft anastomosed to the femoral artery in 1).
  
  
  RESULTS
  Femoral artery diameter was smaller in the ALT group than in the SF group (6.5 ± 0.5 vs. 7.3 ± 1.0 mm, P = 0.013). Operating time was longer in the ALT group than in the SF group (259.2 ± 54.0 vs. 208.3 ± 54.9 min, P = 0.031). One patient was converted to ascending aortic cannulation owing to high perfusion pressure. Postoperative major cardiac or cerebrovascular events, such as death, stroke, or myocardial infarction, did not occur in either group.
  
  
  CONCLUSIONS
  Alternative perfusion access was safe in ASD closure via a right minithoracotomy approach. Precise preoperative evaluation of the iliofemoral artery is important for choosing the appropriate perfusion strategy.
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kitahara
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kazuma@keio.jp.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Mikihiko
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshitake
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Inaba
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Akamatsu
authors.affiliation: Department of Cardiovascular Surgery, Keio University Hospital, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002404:Catheterization; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061646:Operative Time; D010477:Perfusion / Q000379:methods*; D011184:Postoperative Period; D013908:Thoracotomy / Q000379:methods*; D055815:Young Adult
keywords: Cardiopulmonary bypass; Congenital heart disease; Minimally invasive surgery