Cerebral Hypoxia Caused by Flow Confliction During Minimally Invasive Cardiac Surgery With Retrograde Perfusion: A Word of Caution

CURRENTLY, MINIMALLY INVASIVE cardiac surgery (MICS) is very popular. In most cases, cardiopulmonary
bypass (CPB) is used with femoral arterial cannulation, and the whole body is perfused in a retrograde fashion. However, in cases of inadequate venous drainage for the CPB, antegrade blood flow from the patient’s left ventricular cardiac output becomes hypoxic if the ventilator is stopped intentionally for surgical manipulations. In such a situation, the antegrade hypoxic blood flow meets the retrograde oxygenated blood from the CPB somewhere in the aorta. If the line of flow confliction is positioned distal to the arch vessels, fulminant cerebral hypoxia can occur (Fig 1). However, this fatal phenomenon may not be well recognized in typical surgical settings.
Here the authors report a case of cerebral hypoxia caused by flow confliction during MICS that was detected by a multidisciplinary approach including laser speckle flowgraphy (LSFG), near infrared spectroscopy (NIRS), and transesophageal echocardiography (TEE).
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