Percutaneous Superior Vena Cava Drainage During Minimally Invasive Mitral Valve Surgery: A Randomized, Crossover Study

Objective: Minimally invasive techniques commonly are applied to mitral valve surgery; however, there has been little research investigating the optimal methods of cardiopulmonary bypass for the right minithoracotomy approach. Controversy exists as to whether a percutaneous superior vena cava drainage cannula (PSVC) is necessary during these operations. The authors, therefore, sought to determine the effect of using a percutaneous superior vena cava catheter on brain near-infrared spectroscopy, blood lactate levels, hemodynamics and surgical parameters. Design: Randomized, blinded, crossover trial. Setting: Tertiary care university hospital. Participants: Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy. Interventions: Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage, during mitral valve repair. Measurement and Main Results: For the primary outcome of brain near-infrared spectroscopy, there were no differences between the two groups (percutaneous superior vena cava clamped 55.0% +/- 11.6% versus unclamped 56.1% +/- 10.2%) (p = 0.283). For the secondary outcomes pH (clamped 7.35 +/- 0.05 versus unclamped 7.37 +/- 0.05 p = 0.015), surgical score (clamped 1.96 +/- 1.14 versus unclamped 1.22 +/- 0.51 p = 0.002) and CVP (clamped 11.6 mmHg +/- 4.8 mmHg versus unclamped 6.1 mmHg +/- 6.1 mmHg p <0.001) were significantly different. Conclusions: The use of a percutaneous superior vena cava drainage improved surgical visualization and lowered CVP, but had no effect on brain near infrared spectroscopy during minimally invasive mitral valve surgery. (C) 2014 Elsevier Inc. All rights reserved.