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Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

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ABSTRACT

Background: The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.

Methods: The patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon’s direct inspection in the surgical field was performed. The range −1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.

Results: A total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon’s inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05–0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.

Conclusions: Preoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.

Trial registration: This study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477).

Electronic supplementary material: The online version of this article (doi:10.1186/s12871-017-0347-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Coronal planes of cardiac computed tomography showing the level of the upper border of the sternal clavicle (a) and the level of the junction between the superior vena cava and right atrium (b)
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Fig1: Coronal planes of cardiac computed tomography showing the level of the upper border of the sternal clavicle (a) and the level of the junction between the superior vena cava and right atrium (b)

Mentions: To determine the adequate depth of SVC cannula insertion, two lengths were measured: the shortest straight distance between the insertion point of the needle and the level of the upper border of the clavicular sternal head using a sterile disposable ruler, and the distance between the upper border of the clavicular sternal head and the SVC-RA junction in the coronal planes of the cardiac CT. The starting point of the line was fixed at the upper border of the clavicular sternal head in one plane; the line was then continued to another plane showing the SVC-RA junction to end at the SVC-RA junction followed by drawing a line to SVC-RA junction (Fig. 1). Finally, the SVC cannula was inserted to a depth that was determined by the sum of the two measurements minus 1.0–1.5 cm, when surgery involving only the left side of the heart was scheduled, or 2.0–3.0 cm, when surgery involving the right side of the heart was scheduled, as appropriate. The corrected distance from the upper border of the clavicular sternal head to SVC-RA junction was defined as the distance that was adjusted from the measured distance on cardiac CT by the surgeon’s measurement in the surgical field. Here, the surgeon’s measurement was the distance from the SVC cannula tip to the SVC-RA junction in the surgical field, as mentioned above. For example, if the distance from the upper border of the clavicular sternal head to the SVC-RA junction on cardiac CT was 10.0 cm with the SVC cannular tip being planned to be placed 2.0 cm above the SVC-RA junction, and the SVC cannular tip was verified as being positioned 3.0 cm above the SVC-RA junction by the cardiac surgeon, then the corrected distance from the upper border of the clavicular sternal head to the SVC-RA junction was 11.0 cm. The distance between the upper border of the clavicular sternal head and the SVC-RA junction on cardiac CT was measured independently by two investigators. The measurement of the first investigator was used in the analysis.Fig. 1


Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study
Coronal planes of cardiac computed tomography showing the level of the upper border of the sternal clavicle (a) and the level of the junction between the superior vena cava and right atrium (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5383961&req=5

Fig1: Coronal planes of cardiac computed tomography showing the level of the upper border of the sternal clavicle (a) and the level of the junction between the superior vena cava and right atrium (b)
Mentions: To determine the adequate depth of SVC cannula insertion, two lengths were measured: the shortest straight distance between the insertion point of the needle and the level of the upper border of the clavicular sternal head using a sterile disposable ruler, and the distance between the upper border of the clavicular sternal head and the SVC-RA junction in the coronal planes of the cardiac CT. The starting point of the line was fixed at the upper border of the clavicular sternal head in one plane; the line was then continued to another plane showing the SVC-RA junction to end at the SVC-RA junction followed by drawing a line to SVC-RA junction (Fig. 1). Finally, the SVC cannula was inserted to a depth that was determined by the sum of the two measurements minus 1.0–1.5 cm, when surgery involving only the left side of the heart was scheduled, or 2.0–3.0 cm, when surgery involving the right side of the heart was scheduled, as appropriate. The corrected distance from the upper border of the clavicular sternal head to SVC-RA junction was defined as the distance that was adjusted from the measured distance on cardiac CT by the surgeon’s measurement in the surgical field. Here, the surgeon’s measurement was the distance from the SVC cannula tip to the SVC-RA junction in the surgical field, as mentioned above. For example, if the distance from the upper border of the clavicular sternal head to the SVC-RA junction on cardiac CT was 10.0 cm with the SVC cannular tip being planned to be placed 2.0 cm above the SVC-RA junction, and the SVC cannular tip was verified as being positioned 3.0 cm above the SVC-RA junction by the cardiac surgeon, then the corrected distance from the upper border of the clavicular sternal head to the SVC-RA junction was 11.0 cm. The distance between the upper border of the clavicular sternal head and the SVC-RA junction on cardiac CT was measured independently by two investigators. The measurement of the first investigator was used in the analysis.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: The determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.

Methods: The patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon’s direct inspection in the surgical field was performed. The range −1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.

Results: A total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon’s inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05–0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.

Conclusions: Preoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.

Trial registration: This study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477).

Electronic supplementary material: The online version of this article (doi:10.1186/s12871-017-0347-x) contains supplementary material, which is available to authorized users.

No MeSH data available.