Complications And Its Prevention Of Femoral Vessels After Da Vinci Robotic Heart Surgery

Objective By studying Da Vinci cardiac surgery patients who received extracorporeal circulation through the femoral artery and femoral vein catheterization,the present study aimed to investigate the short-and medium-term recovery of catheterized blood vessels and surrounding tissues and to explore the complications that might be caused by extracorporeal circulation in da Vinci cardiac surgery.To evaluate the clinical significance of anticoagulant therapy by grouping patients after Da Vinci heart surgery.And to evaluate the preventive effect of combined application of aspirin,warfarin and antithrombotic pressure pump on related thrombotic complications,so as to provide new ideas for preventing vascular complications and improving the patient prognosis after da Vinci cardiac surgery.Methods The patients who underwent cardiac valve replacement/plasty,atrial/ventricular septal defect repair and cardiac mass resection in the Department of Cardiovascular Surgery of The Affiliated Hospital of Qingdao University assisted with da Vinci robotic surgery system were selected for a retrospective study on the vascular recovery following postoperative extracorporeal circulation catheterization.Basic information including sex,age,surgery technique,and vascular ultrasound of lower extremities,extracorporeal circulation time,femoral vessels cannulation diameter were collected and recorded.The revisit data of perioperative and postoperative periods were obtained,including the vascular ultrasound of lower extremities and the inguinal incision recovery were obtained to explore the possible complications related to catheterization.A study was conducted on the prevention of lower extremities venous thrombosis post da Vinci cardiac surgery.To prevent postoperative femoral vein thrombosis,the patients were divided into four groups:an anticoagulation-free group,a physical anticoagulation group,a warfarin + physical anticoagulation group and an aspirin + physical anticoagulation group,and the results were compared.The measurement data were expressed as mean ± standard deviation((?)± s),and the hypothesis test was carried out using t-test.The counting data were expressed as a percentage(%)and tested using chi-square analysis.According to the analysis results,the anticoagulation therapy of catheterized extracorporeal circulation after da Vinci robotic heart surgery was evaluated.Results Between November 2014 and March 2018,a total of 176 patients underwent da Vinci cardiac surgery.According to the inclusion and exclusion criteria,152 patients were included in the present study.There were 72 males(47.4%)and 80 females(52.6%),with an average age of 52.6 ± 9.5 years.The average surgery time was 246.7 ± 65.1 min,and the average intraoperative time of extracorporeal circulation was 134.5 ± 38.3 min.No perioperative and postoperative death was reported.During the perioperative period and follow-up,5 cases(3.3%)developed inguinal incision infection and 3(2.0%)reported inguinal subcutaneous hematoma.The above 8 patients occurred inguinal incision complications were cured after follow-up treatment.No complication of femoral artery was observed.There were 7 patients(4.6%)occurred femoral vein thrombosis.Among them,3cases(2.0%)with obvious symptoms improved after hospitalization,and ultrasound reexamination findings indicated venous recanalization.The other 4 asymptomatic patients(2.6%)performed lower limb vascular ultrasound and the results indicated that the thrombus was small and long-term outpatient revisits were suggested.Between April 2018 and August 2020,a total of 311 patients underwent da Vinci cardiac surgery.According to the inclusion and exclusion criteria,227 patients were included in the present study.Of them,there were 97 patients in the anticoagulation-free group,34 patients in the physical anticoagulation group,65 patients in the warfarin + physical anticoagulation group and 31 patients in the aspirin + physical anticoagulation group.Seven(7.2%)reported lower extremity venous thrombosis in the anticoagulation-free group.Three(8.8%)reported lower extremity venous thrombosis in the physical anticoagulation group,and one(2.9%)developed inguinal incision infection.No patients developed femoral arteriovenous thrombosis in the warfarin + physical anticoagulation group,but 2 case(3.1%)occurred inguinal subcutaneous hematoma and 3 case(4.6%)developed inguinal incision infection.There was 1 case(3.2%)with inguinal subcutaneous hematoma in the aspirin + physical anticoagulation group.Conclusions Among patients underwent da Vinci robotic heart surgery,complications caused by peripheral extracorporeal circulation included femoral vein thrombosis and inguinal incision infection.Improved femoral artery catheterization of extracorporeal circulation can reduce the incidence of femoral artery complications.Routine reexamination of lower extremity vascular ultrasound is an effective measure to detect and treat femoral vein thrombosis complications in time.The patients developed complications could be cured following treatment or conservative observations,and the complications exerted no notable effect on the prognosis and quality of life of the patients.Anticoagulant therapy is necessary after da Vinci cardiac surgery with extracorporeal circulation catheterization,drugs plus physical prophylactic therapy could prevent target vessel thrombosis more effectively than the application of simple physical therapy(P < 0.05).The preventive drugs indicated no substantial difference in the clinical efficacy of either use of warfarin or aspirin.