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(Circulation. 1997;96:562-568.)
© 1997 American Heart Association, Inc.

Articles

Monitoring Considerations for Port-Access Cardiac Surgery

Lawrence C. Siegel, MD; Frederick G. St. Goar, MD; John H. Stevens, MD; Mario F. Pompili, MD; Thomas A. Burdon, MD; Bruce A. Reitz, MD; ; William S. Peters, MB, ChB

From the Department of Anesthesia (L.C.S.), Division of Cardiology (F.G. St. G.), and Department of Cardiothoracic Surgery (J.H.S., M.F.P., T.A.B., B.A.R., W.S.P.), Stanford (Calif) University School of Medicine, and the Division of Cardiothoracic Surgery, Palo Alto (Calif) Veterans Affairs Health Care System (M.F.P., T.A.B.).

Correspondence to Lawrence C. Siegel, MD, PO Box 117098, Burlingame, CA 94011-7098. E-mail lsiegel{at}leland.stanford.edu

Background A method for monitoring patients was evaluated in a clinical trial of minimally invasive port-access cardiac surgery with closed chest endovascular cardiopulmonary bypass.

Methods and Results Cardiopulmonary bypass was conducted in 25 patients through femoral cannulas. An endovascular pulmonary artery vent was placed in the main pulmonary artery through a jugular vein. For mitral valve surgery, a catheter was placed in the coronary sinus for delivery of cardioplegia. A balloon catheter ("endoaortic clamp," EAC) used for occlusion of the ascending aorta, delivery of cardioplegia, aortic root venting, and pressure measurement was inserted through a femoral artery and initially positioned by use of fluoroscopy and transesophageal echocardiography (TEE). Potential migration of the EAC was monitored by (1) TEE of the ascending aorta, (2) pulsed-wave Doppler of the right carotid artery, (3) balloon pressure, (4) comparison of aortic root pressure and right radial artery pressure, and (5) fluoroscopy. TEE, fluoroscopy, and pressure measurement were effective in monitoring catheter insertion and position. With inadequate balloon inflation, migration of the EAC toward the aortic valve could be detected with TEE. During administration of cardioplegia, TEE showed movement of the balloon away from the aortic valve, and migration into the aortic arch was detectable with loss of carotid Doppler flow. Stability of EAC position was demonstrated with appropriate balloon volume. Cardioplegic solution was visualized in the aortic root, and aortic root pressure changed appropriately during administration of cardioplegia. Venous cannula position was optimized with TEE and endopulmonary vent flow measurement.

Conclusions An effective method has been developed for monitoring patients and the catheter system during port-access cardiac surgery.

Key Words: surgery • cardiopulmonary bypass • echocardiography • imaging

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