Abstract：
UNASSIGNED: Lower-limb ischemia is a complication of minimally invasive cardiac surgery with femoral cannulation. Herein, we verified our strategy using distal perfusion cannulation (DPC) against this complication.
UNASSIGNED: We retrospectively assessed 91 cases of aortic valve replacement with femoral cannulation between January 2019 and March 2023. DPC was applied when lower-limb tissue oxygenation index declined by ≥20%. The cannula to femoral artery diameter ratio (C/FA) was calculated by dividing the cannula size (Fr) divided by 3 by the femoral artery inner diameter (mm). Postoperative maximum creatinine kinase (CKmax), lactate dehydrogenase (LDHmax), and lactate levels were analyzed, and univariable logistic regression and receiver operating characteristic curve analyses were employed to determine DPC predictors and the cutoff C/FA for DPC, respectively. Patients without DPC were divided into 2 subgroups based on the cutoff C/FA for further comparisons.
UNASSIGNED: DPC was required in 9 patients. Symptomatic ischemia was not observed. All laboratory data were similar in the DPC and non-DPC groups. C/FA was significantly associated with DPC (odds ratio = 1.27, 95% confidence interval: 1.09 to 1.47, P = 0.002), and the cutoff C/FA was 0.70 (sensitivity = 0.89, specificity = 0.80). In the non-DPC group, CKmax (P = 0.027) and LDHmax (P = 0.041) were significantly higher in patients with C/FA ≥0.7 (n = 16) than in those with C/FA <0.7 (n = 66).
UNASSIGNED: Our strategy for preventing symptomatic ischemia is reasonable and could be almost achieved without DPC when C/FA is <0.7. C/FA also predicts asymptomatic potential ischemia, and proactive DPC is preferable when C/FA is ≥0.7.
UNASSIGNED: We retrospectively assessed 91 cases of aortic valve replacement with femoral cannulation between January 2019 and March 2023. DPC was applied when lower-limb tissue oxygenation index declined by ≥20%. The cannula to femoral artery diameter ratio (C/FA) was calculated by dividing the cannula size (Fr) divided by 3 by the femoral artery inner diameter (mm). Postoperative maximum creatinine kinase (CKmax), lactate dehydrogenase (LDHmax), and lactate levels were analyzed, and univariable logistic regression and receiver operating characteristic curve analyses were employed to determine DPC predictors and the cutoff C/FA for DPC, respectively. Patients without DPC were divided into 2 subgroups based on the cutoff C/FA for further comparisons.
UNASSIGNED: DPC was required in 9 patients. Symptomatic ischemia was not observed. All laboratory data were similar in the DPC and non-DPC groups. C/FA was significantly associated with DPC (odds ratio = 1.27, 95% confidence interval: 1.09 to 1.47, P = 0.002), and the cutoff C/FA was 0.70 (sensitivity = 0.89, specificity = 0.80). In the non-DPC group, CKmax (P = 0.027) and LDHmax (P = 0.041) were significantly higher in patients with C/FA ≥0.7 (n = 16) than in those with C/FA <0.7 (n = 66).
UNASSIGNED: Our strategy for preventing symptomatic ischemia is reasonable and could be almost achieved without DPC when C/FA is <0.7. C/FA also predicts asymptomatic potential ischemia, and proactive DPC is preferable when C/FA is ≥0.7.
摘要：
■下肢缺血是股骨插管微创心脏手术的并发症。在这里，我们使用远端灌注插管(DPC)验证了我们针对这种并发症的策略.
■我们回顾性评估了2019年1月至2023年3月期间用股动脉插管进行主动脉瓣置换术的91例。当下肢组织氧合指数下降≥20%时应用DPC。通过将套管尺寸(Fr)除以3除以股动脉内径(mm)来计算套管与股动脉直径比(C/FA)。术后最大肌酐激酶（CKmax），乳酸脱氢酶（LDHmax），和乳酸水平进行了分析，单变量逻辑回归和受试者工作特征曲线分析用于确定DPC预测因子和DPC的截止C/FA，分别。没有DPC的患者根据截止值C/FA分为2个亚组进行进一步比较。
■9例患者需要DPC。未观察到症状性缺血。DPC和非DPC组的所有实验室数据相似。C/FA与DPC显著相关(比值比=1.27,95%置信区间:1.09~1.47,P=0.002),截止C/FA为0.70（敏感性=0.89，特异性=0.80）。在非DPC组中，C/FA≥0.7(n=16)患者的CKmax(P=0.027)和LDHmax(P=0.041)明显高于C/FA<0.7(n=66)患者。
■我们预防症状性缺血的策略是合理的，当C/FA<0.7时，没有DPC几乎可以实现。C/FA还可以预测无症状的潜在缺血，当C/FA≥0.7时，主动DPC是优选的。
■我们回顾性评估了2019年1月至2023年3月期间用股动脉插管进行主动脉瓣置换术的91例。当下肢组织氧合指数下降≥20%时应用DPC。通过将套管尺寸(Fr)除以3除以股动脉内径(mm)来计算套管与股动脉直径比(C/FA)。术后最大肌酐激酶（CKmax），乳酸脱氢酶（LDHmax），和乳酸水平进行了分析，单变量逻辑回归和受试者工作特征曲线分析用于确定DPC预测因子和DPC的截止C/FA，分别。没有DPC的患者根据截止值C/FA分为2个亚组进行进一步比较。
■9例患者需要DPC。未观察到症状性缺血。DPC和非DPC组的所有实验室数据相似。C/FA与DPC显著相关(比值比=1.27,95%置信区间:1.09~1.47,P=0.002),截止C/FA为0.70（敏感性=0.89，特异性=0.80）。在非DPC组中，C/FA≥0.7(n=16)患者的CKmax(P=0.027)和LDHmax(P=0.041)明显高于C/FA<0.7(n=66)患者。
■我们预防症状性缺血的策略是合理的，当C/FA<0.7时，没有DPC几乎可以实现。C/FA还可以预测无症状的潜在缺血，当C/FA≥0.7时，主动DPC是优选的。
