Control of Port Site Bleeding With Liberal Use of Catheter Balloon Tamponade in Robotic Mitral Valve Surgery.

IF 1.6 Q2 SURGERY
Steven S Qi, Kaitlin Grady, Hiroto Kitahara, Sarah Nisivaco, Blaine Johnson, Yusuke Tsukioka, Husam H Balkhy
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引用次数: 0

Abstract

Objective: Port sites are a common source of perioperative bleeding in robotic cardiac surgery, which can be exacerbated by patient anatomy and anticoagulation. We present results from the liberal usage of a balloon-tipped coudé catheter for tamponade of robotic port sites during robotic mitral surgery.

Methods: All patients who underwent robotic mitral valve surgery at our institution from August 2016 to July 2022 were studied (N = 320). Patients converted to sternotomy were excluded (n = 5). Patients were then divided into 2 groups for before or after implementation of a protocol for the liberal use of balloon tamponade for patients with port site bleeding refractory to cautery. Catheter balloon tamponade was applied to a bleeding port site while weaning from cardiopulmonary bypass and usually removed after protamine administration. In rare cases of severe coagulopathy, the catheter was left inserted and removed in the intensive care unit after the coagulopathy resolved.

Results: A total of 315 patients were divided into a pre-protocol group ("control," n = 127) and a post-protocol group ("balloon," n = 188). The balloon group showed lower rates of reoperation for bleeding (0% vs 4.7%, P = 0.004), lower rates of pacemaker insertion (0.5% vs 3.9%, P = 0.04), and higher rates of chest tube removal on the first postoperative day (83% vs 70%, P = 0.01). Postoperative and intraoperative transfusion rates as well as hospital length of stay were similar between groups.

Conclusions: The liberal use of intraoperative balloon tamponade of robotic port sites may decrease the risk of bleeding complications in robotic mitral valve surgery.

机器人二尖瓣手术中自由使用导管球囊填塞控制瓣口出血。
目的:贲门部位是机器人心脏手术围手术期出血的常见来源,患者解剖和抗凝可能会加剧出血。我们介绍了在机器人二尖瓣手术中,自由使用球囊尖端导管填塞机器人端口部位的结果。方法:研究2016年8月至2022年7月在我院接受二尖瓣机器人手术的所有患者(N = 320)。排除改用胸骨切开术的患者(n = 5)。然后将患者分为两组,分别在实施方案之前或之后,对难治性端口出血患者自由使用球囊填塞。导管球囊填塞在体外循环脱机时用于出血部位,通常在给予鱼精蛋白后取出。在罕见的严重凝血功能障碍病例中,在凝血功能障碍消退后,在重症监护病房将导管插入并取出。结果:共有315例患者被分为方案前组(“对照”,n = 127)和方案后组(“气球”,n = 188)。气囊组出血再手术率较低(0%对4.7%,P = 0.004),起搏器插入率较低(0.5%对3.9%,P = 0.04),术后第一天胸管拔除率较高(83%对70%,P = 0.01)。两组之间的术后和术中输血率以及住院时间相似。结论:在机器人二尖瓣手术中,术中自由使用球囊填塞可降低机器人二尖瓣手术出血并发症的风险。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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