ArticleJournal of thoracic disease2026
Risk factors for lower limb ischemia in minimally invasive and robotic-assisted cardiac valve surgery: a retrospective cohort study.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
Background: Lower limb ischemia is a critical complication of femoral cannulation during minimally invasive and robot-assisted cardiac surgery. We aimed to evaluate the validity of our intraoperative near-infrared spectroscopy (NIRS) monitoring strategy and identify risk factors for distal perfusion. Methods: We retrospectively analyzed 329 patients who underwent minimally invasive or robotic-assisted cardiac surgery with ipsilateral femoral arteriovenous cannulation between 2014 and June 2025. The primary outcome was intraoperative Tissue oxygenation index (TOI) desaturation requiring distal perfusion, defined as a >10% decline from baseline in the cannulated limb. Femoral artery (FA) diameter and femoral vein (FV) cross-sectional area were measured on preoperative computed tomography (CT). Risk factors were assessed by logistic regression, and receiver operating characteristic (ROC) analysis determined optimal cut-off values. Results: Intraoperative TOI desaturation requiring distal perfusion occurred in 34 patients (10.3%). Multivariable analysis revealed that age (P=0.03) and FA-cannula diameter difference (P<0.001) were independent predictors. The optimal FA-cannula diameter difference cut-off was 1.7 mm. No postoperative limb complications occurred, and postoperative enzyme levels were not elevated in those requiring distal perfusion. Conclusions: A smaller FA-cannula diameter difference and younger age independently predicted intraoperative lower limb ischemia. NIRS-guided distal perfusion may be a safe and effective strategy to prevent ischemic complications.
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