European journal of medical research · 2025
Optimization of carbon dioxide insufflation strategies in minimally invasive cardiac surgery: the efficacy of continuous insufflation protocols with left ventricular venting.
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Hu Zhibin, Mao Wenshuai, Guo Lijun, Liu Zhiwei, Hu Xujie, Wang Shuwei, Zhou Bing, Cui Yong
Аннотация
OBJECTIVES: Although CO₂ insufflation play an established role in open-heart surgery, its optimal application in minimally invasive cardiac procedures remains unclear. This study systematically compared continuous versus single CO₂ insufflation protocols during minimally invasive modified morrow procedures, and assessed the influence of left heart venting modality on microbubble clearance efficacy.
METHODS: This retrospective cohort study included 351 patients undergoing minimally invasive modified morrow procedures (2023-2024). Participants were stratified into two groups: Continuous Insufflation Group (CIG, n = 228; 5 L/min CO₂ throughout cardiopulmonary bypass [CPB]) and Single Insufflation Group (SIG, n = 123; 5 L/min CO₂ 5-min pre-aortotomy closure to 5-min post-unclamping). Microbubble dynamics were quantitatively classified into four grades (0-III) using standardized intraoperative transesophageal echocardiography. Multivariate logistic regression was used to identify predictors of microbubble formation and clinical outcomes.
RESULTS: The CIG exhibited a statistically significant reduction in overall microbubble incidence compared to SIG (13.60% vs. 36.59%, p < 0.05), particularly in attenuating Grade I-II microbubbles (p < 0.05). Multivariate analysis identified CO₂ insufflation strategy (odds ratio [OR] = 3.694, p = 0.005), left heart venting modality (OR = 32.527, p < 0.001), and CPB time (OR = 1.017, p = 0.017) as independent predictors. Importantly, the combination of continuous insufflation with left ventricular venting was associated with a 93.3% reduction in Grade I microbubbles (OR = 0.067, p = 0.001). Clinically, the CIG exhibited a lower incidence of perioperative arrhythmias (24.12% vs. 36.59%, p = 0.009), despite slightly longer hospitalization (9.80 ± 4.42d vs. 8.88 ± 3.26d, p < 0.05). Neurological outcomes (4.82% vs. 3.25%, p = 0.483) and ICU stay duration (1.59 ± 1.69d vs. 1.74 ± 2.14d, p = 0.215) were comparable between groups.
CONCLUSION: In the context of the minimally invasive modified morrow procedure, continuous CO₂ insufflation significantly reduces microbubble formation and perioperative arrhythmias. Left ventricular venting modality is a key determinant of de-airing efficacy. Protocol optimization should prioritize continuous CO₂ insufflation in combination with left ventricular venting systems to enhance procedural safety.
METHODS: This retrospective cohort study included 351 patients undergoing minimally invasive modified morrow procedures (2023-2024). Participants were stratified into two groups: Continuous Insufflation Group (CIG, n = 228; 5 L/min CO₂ throughout cardiopulmonary bypass [CPB]) and Single Insufflation Group (SIG, n = 123; 5 L/min CO₂ 5-min pre-aortotomy closure to 5-min post-unclamping). Microbubble dynamics were quantitatively classified into four grades (0-III) using standardized intraoperative transesophageal echocardiography. Multivariate logistic regression was used to identify predictors of microbubble formation and clinical outcomes.
RESULTS: The CIG exhibited a statistically significant reduction in overall microbubble incidence compared to SIG (13.60% vs. 36.59%, p < 0.05), particularly in attenuating Grade I-II microbubbles (p < 0.05). Multivariate analysis identified CO₂ insufflation strategy (odds ratio [OR] = 3.694, p = 0.005), left heart venting modality (OR = 32.527, p < 0.001), and CPB time (OR = 1.017, p = 0.017) as independent predictors. Importantly, the combination of continuous insufflation with left ventricular venting was associated with a 93.3% reduction in Grade I microbubbles (OR = 0.067, p = 0.001). Clinically, the CIG exhibited a lower incidence of perioperative arrhythmias (24.12% vs. 36.59%, p = 0.009), despite slightly longer hospitalization (9.80 ± 4.42d vs. 8.88 ± 3.26d, p < 0.05). Neurological outcomes (4.82% vs. 3.25%, p = 0.483) and ICU stay duration (1.59 ± 1.69d vs. 1.74 ± 2.14d, p = 0.215) were comparable between groups.
CONCLUSION: In the context of the minimally invasive modified morrow procedure, continuous CO₂ insufflation significantly reduces microbubble formation and perioperative arrhythmias. Left ventricular venting modality is a key determinant of de-airing efficacy. Protocol optimization should prioritize continuous CO₂ insufflation in combination with left ventricular venting systems to enhance procedural safety.