Distal leg protection for peripheral cannulation in minimally invasive and totally endoscopic cardiac surgery.

Background: The introduction of minimally invasive and totally endoscopic cardiac surgery is associated with increased use of femoral artery perfusion. Selective antegrade perfusion of the cannulated artery may be a helpful strategy to avoid ischemia of the lower extremities. The aim of the study was to evaluate the efficacy of selective distal vessel perfusion under continuous monitoring of oxygen saturation using near-infrared spectroscopy (NIRS). Methods: All patients (n = 236) who underwent peripheral cannulation for remote access perfusion and endoaortic balloon occlusion for minimally invasive or totally endoscopic cardiac surgery were prospectively analyzed. Perioperative complications, creatine kinase levels, and major complications at the long-term follow-up were recorded. Results: Minor or major complications of leg perfusion occurred in only 4 patients (1.7%); the complications in 2 of the patients were associated with an additional arterial cannula placed at the contralateral side. NIRS monitoring revealed diminished perfusion in 5 cases. Even patients with complications associated with remote-access perfusion had a rapid recovery, and no residual peripheral vascular complication was detected during follow-up. Conclusions: The use of antegrade selective perfusion of the lower extremity at the side of peripheral cannulation for port-access perfusion and endoaortic occlusion is of utmost importance in patients undergoing minimally invasive or endoscopic cardiac surgery. NIRS monitoring has proved to be very helpful for the diagnosis of impaired leg perfusion.