학술논문
Patient tilt improves efficacy of CO2 field-flooding in minimally invasive cardiac surgery
Document Type
Academic Journal
Source
Journal of Cardiothoracic Surgery. June 22, 2022, Vol. 17 Issue 1
Subject
Language
English
ISSN
1749-8090
Abstract
Author(s): Stijn Vandenberghe[sup.1,2], Geni Singjeli[sup.2] and Stefanos Demertzis[sup.1,2] Background Air emboli formed during open-heart surgery result in frequent incidences of cardiac or neurological adverse events [1, 2]. On the cardiac [...]
Objective Space limitations during minimally invasive cardiac surgery impede consistent use of CO.sub.2 field-flooding. We compared different gas delivery methods, flow rates and the effect of patient inclination. Methods A gastight model of MICS surgery with internal organs and right thoracotomy wound was created from a mannequin and equipped with a CO.sub.2 concentration sensor in the left ventricle. Maximum achievable CO.sub.2 concentration was compared for gas delivery via three commercial CO.sub.2 diffusors (CarbonMini, Temed, Andocor) and also via a trocar with side port. Gas flow rates of 1, 3, 5 and 8 L per minute were tested. The model was placed either in supine position or with 20[degrees] oblique tilt. A simplified transparent model was also created and placed in an optical test bench to evaluate the gas cloud motions via real-time visualization. Results The trocar consistently achieved higher CO.sub.2 concentrations inside the left ventricle. At 1 l/min, approximately 2.5 min were needed to fill the supine model to its maximum CO.sub.2 concentration, which was limited to a range of 48-82% in the left ventricle. At higher flow rates, filling time and concentration were significantly improved. In a tilted model, all devices and all flow rates generated on average 99% CO.sub.2 in the ventricle. Imaging revealed constant gas exchange via the main incision, with CO.sub.2 outflow via bottom and air inflow via the top of the incision. Conclusions CO.sub.2 field flooding in minimally invasive cardiac surgery is highly effective if the patient is tilted. Else a flow rate of 5 l/min is recommended to achieve the same protection. Keywords: Minimally invasive, Field-flooding, Carbondioxide, Neuroprotection, Diffusor
Objective Space limitations during minimally invasive cardiac surgery impede consistent use of CO.sub.2 field-flooding. We compared different gas delivery methods, flow rates and the effect of patient inclination. Methods A gastight model of MICS surgery with internal organs and right thoracotomy wound was created from a mannequin and equipped with a CO.sub.2 concentration sensor in the left ventricle. Maximum achievable CO.sub.2 concentration was compared for gas delivery via three commercial CO.sub.2 diffusors (CarbonMini, Temed, Andocor) and also via a trocar with side port. Gas flow rates of 1, 3, 5 and 8 L per minute were tested. The model was placed either in supine position or with 20[degrees] oblique tilt. A simplified transparent model was also created and placed in an optical test bench to evaluate the gas cloud motions via real-time visualization. Results The trocar consistently achieved higher CO.sub.2 concentrations inside the left ventricle. At 1 l/min, approximately 2.5 min were needed to fill the supine model to its maximum CO.sub.2 concentration, which was limited to a range of 48-82% in the left ventricle. At higher flow rates, filling time and concentration were significantly improved. In a tilted model, all devices and all flow rates generated on average 99% CO.sub.2 in the ventricle. Imaging revealed constant gas exchange via the main incision, with CO.sub.2 outflow via bottom and air inflow via the top of the incision. Conclusions CO.sub.2 field flooding in minimally invasive cardiac surgery is highly effective if the patient is tilted. Else a flow rate of 5 l/min is recommended to achieve the same protection. Keywords: Minimally invasive, Field-flooding, Carbondioxide, Neuroprotection, Diffusor