title: Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study.
abstract: The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.
  
  
  
  The patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon's direct inspection in the surgical field was performed. The range -1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.
  
  
  
  A total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon's inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05-0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.
  
  
  
  Preoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.
  
  
  
  This study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477) .
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Chin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. leho@naver.com.
authors.forename: Eun-Ho
authors.identifier: 0000-0002-6369-7429
authors.initials: EH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Jong-Il
authors.initials: JI
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: In-Cheol
authors.initials: IC
authors.lastname: Choi
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods; D002405:Catheterization, Central Venous / Q000379:methods*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*
keywords: Cardiac computed tomography; Minimally invasive cardiac surgery; Superior vena cava cannulae