Superior Vena Cava Canulation During Minimally Invasive Cardiac Surgery: A Better Choice than Percutaneous Internal Jugular Vein for Venous Drainage

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-10-10 DOI:10.1155/jocs/1277604

Yufei Zhan, Hua Lu, Quan Shi, Shengjie Liao, Tiange Luo, Yipeng Ge, Xiaoshen Zhang

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Abstract

Backgrounds

Venous drainage is a critical aspect of peripheral cardiopulmonary bypass (CPB) management in minimally invasive cardiac surgery (MICS), particularly for superior vena cava (SVC) drainage. The most commonly used method for SVC drainage currently is percutaneous cannulation via the internal jugular vein. However, this method still faces challenges in drainage efficiency, cosmetic outcomes, and puncture-related complications. This study aimed to compare the safety, effectiveness, and cosmetic outcomes of direct SVC cannulation (SVCC) and percutaneous internal jugular vein (PIJV) for SVC drainage in MICS.

Methods

A retrospective analysis was conducted of patients who underwent MICS with CPB at the Cardiovascular Surgery Department of the First Affiliated Hospital of Jinan University and Guangdong General Hospital between January 2012 and August 2023. In this study, 499 patients underwent SVCC, and 572 patients received PIJV for SVC drainage.

Results

In the SVCC group, one central venous catheter was mistakenly fixed with a purse-string suture (0.2%). In the PIJV group, complications included neck hematoma in 11 cases (1.9%), puncture site infection in 3 cases (0.5%), and catheter failure in 1 case (0.2%). Significant differences were noted in central venous pressure (CVP) during aortic cross-clamping (p < 0.001), duration of mechanical ventilation (p = 0.049), pleural drainage volume (p = 0.001) and lactate levels at Intensive Care Unit (ICU) admission (p < 0.001) between the two groups. Additionally, lactate levels were significantly different only in the subgroup of patients weighing > 50 kg. Patients with a CVP ≤ 0 mmHg during aortic cross-clamping exhibited lower lactate levels on ICU admission than those with CVP > 0 mmHg.

Conclusion

SVCC in MICS provides an easy and safe method with minimal complications, improved venous drainage, and better cosmetic results than the PIJV method.

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微创心脏手术中上腔静脉插管：比经皮颈内静脉引流更好的选择

背景静脉引流是微创心脏手术（MICS）外周体外循环（CPB）管理的一个关键方面，特别是上腔静脉（SVC）引流。目前最常用的SVC引流方法是经皮颈内静脉插管。然而，这种方法在引流效率、美容效果和穿刺相关并发症方面仍面临挑战。本研究旨在比较直接SVC插管（SVCC）和经皮颈内静脉引流（PIJV）在MICS中SVC引流的安全性、有效性和美容效果。方法回顾性分析2012年1月至2023年8月在暨南大学第一附属医院心血管外科和广东省总医院行MICS合并CPB的患者。在本研究中，499例患者接受SVCC， 572例患者接受PIJV进行SVC引流。结果SVCC组中心静脉导管误用荷包缝合固定1根（0.2%）。PIJV组并发症包括颈部血肿11例（1.9%），穿刺部位感染3例（0.5%），导管失效1例（0.2%）。两组患者主动脉交叉夹紧时的中心静脉压（CVP）（p < 0.001）、机械通气时间（p = 0.049）、胸腔引流量（p = 0.001）和重症监护病房（ICU）入院时的乳酸水平（p < 0.001）均有显著差异。此外，乳酸水平仅在体重50 kg的患者亚组中有显著差异。主动脉交叉夹持期间CVP≤0 mmHg的患者在ICU入院时的乳酸水平低于CVP≤0 mmHg的患者。结论与PIJV法相比，SVCC法简便、安全，并发症少，静脉引流改善，美容效果好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.