Choice Of Arterial Access In Minimally-invasive Mitral Valve Surgery: Axillary Vs. Femoral
Johannes Petersen, Shiho Naito, Niklas Neumann, Christian Detter, Hermann Reichenspurner, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.
Femoral artery perfusion represents a standard cannulation approach in minimally invasive mitral valve surgery, while several limitations due to retrograde aortic perfusion exist. Antegrade arterial flow through the axillary artery has theoretical advantages as compared to the retrograde femoral approach which yet have to be confirmed in the clinical setting. We aimed to compare the postoperative outcomes of axillary artery perfusion vs. retrograde femoral perfusion in the minimally-invasive mitral valve surgery setting.
We systematically analyzed the outcomes of 46 consecutive patients who underwent minimally-invasive mitral valve surgery between 2016 and 2018 using the arterial cannulation of right axillary artery (Group A) due to severe aortic arteriosclerosis. Perioperative outcomes of the study group were compared with a historical control group of retrograde femoral perfusion (Group F) which was adjusted for age and gender (n=46) according to the propensity score matching. Primary endpoint of the study was in-hospital mortality and perioperative cerebrovascular events.
Perioperative risk score values were significantly higher in group A compared to Group F (EuroSCORE II: 3.99±2.57 vs. 1.67±1.58; p = 0.001; STS-Score: 2.19±1.49 vs. 1.31±0.64; p = 0.023). Cardiopulmonary bypass time (group A: 172±46; group F: 178±51 minutes; p= 0.627) and duration of surgery (group A: 260±65; group F: 257±69 minutes; p= 0.870) was comparable in both groups. However, aortic cross clamp time was significantly shorter in the group A as compared to group F (86±20 vs. 111±29 minutes, p < 0.001). There was no perioperative stroke in both study groups. In-hospital mortality was comparable in both groups (p = 0.495). In group A, one patient required median sternotomy and central aortic repair due to intraoperative aortic dissection. No major cardiovascular events occurred in the Group A, despite significantly increased perioperative risk profile.
Right axillary artery perfusion is a safe and reproducible technique in an elderly cohort of patients undergoing minimally-invasive mitral valve surgery who present with the signs of systemic atherosclerosis. Given the appropriate institutional expertise in minimally-invasive mitral valve surgery, high-risk patients with severe arteriosclerosis can be safely treated via the minimally invasive approach using antegrade arterial perfusion.
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