Percutaneous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique for the Future.

Abstract

Introduction:  In recent years, contemporary minimally invasive cardiac surgery techniques have been used in many cardiac surgical clinics. With the expansion of minimally invasive operations, ECMO, and some interventional therapies, the current cardiac surgical landscape requires a thorough knowledge of peripheral cannulation techniques. A venous cannulation that is not flawlessly performed can lead to serious life-threatening complications in several steps. The technique we describe step by step is the current gold standard in terms of safety and efficacy: from the use of ultrasound for ultrasound-guided puncture to the safe advancement of super stiff guidewires using a sentinel catheter and concluding with smooth insertion of the venous cannula over the stiff guidewire up to the SVC. Moreover, a list of bailout maneuvers to solve complications and a report of institutional clinical experience since adopting this technique are presented. Conclusion: In our experience, however, the fact is that patients' perceptions and expectations have changed. Patients increasingly ask for a therapeutic approach that leaves the sternum intact. Those doctors who want to meet this new challenge must realize that minimal incisions in cardiac surgery require excellent technical skills. For this reason, doctors should become familiar with current study data.