Role of preoperative femoral artery color Doppler echocardiography in minimally invasive cardiac surgery.

Objective: Minimally invasive cardiac surgery (MICS) through a right thoracotomy has been developed in the past decades, leading to a significant improvement of postoperative outcome. The risk for complications during peripheral cannulation should be considered. We report our experience of preoperative evaluation by color Doppler echocardiography for patients scheduled for MICS.

Methods: Between January 2009 and December 2011, a total of 155 patients were operated on for mitral valve disease or patent foramen ovale. One hundred thirteen patients were approached by MICS through the fourth intercostal space, and arterial cannulation was peripheral (femoral artery). One hundred nineteen patients scheduled for MICS were screened by ultrasound evaluation before the induction of anesthesia, by means of a vascular linear probe. Three parameters were considered: longitudinal axis, transverse axis, and atherosclerotic disease (AD).

Results: Peripheral arterial cannulation of vessels greater than 7 mm is safe because we experienced no complications in 69 patients. In case of diameters 6.5 to 7 mm, peripheral cannulation should be avoided in case of presence of calcifications; in fact, three patients in our series with AD had vascular injuries; 25 patients without femoral artery AD had no complications. Cannulation was avoided in six patients with widespread AD. In case of diameters less than 6.5 mm, peripheral cannulation was avoided.

Conclusions: Peripheral cannulation is safe when a careful preoperative evaluation is performed. The diameters of the femoral vessels are predictors of complications in case of absence of other contraindications.