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Background: The aim of our study was to compare the safety and efficacy of antegrade arterial perfusion (AAP) and retrograde arterial perfusion (RAP) during minimally invasive mitral valve surgery (MIMVS)
Methods: Retrospective, observational, cohort study of prospectively collected data on 1078 consecutive patients undergoing MIMVS between November 2003 to September 2011 at a single institution. Antegrade arterial perfusion was used in 867 (80.4%) patients and retrograde perfusion in 211 (19.6%). Aortic clamping was direct in 89.4%, with Endoclamp in 9% and no clamp in 1.6 %. In effort to reduce selection bias, 124 patients undergoing antegrade perfusion were matched with 124 patients undergoing retrograde perfusion by propensity score..
Results: After propensity matching, groups were comparable in preoperative characteristics. Relative to AAP, RAP was associated with higher in-hospital mortality (0.5% vs 2.9%; P = .001), incidence of stroke (0.5% vs 2.5%; P = .02), postoperative renal dysfunction (4.9% vs 10.8%; P = .001), and postoperative delirium (3.5% vs 8.2%; P = .03). In multivariable analysis, retrograde arterial perfusion was confirmed to be an independent predictor of neurological complications (odds ratio, 5.74; P = .001).
Conclusions: Antegrade perfusion during minimally invasive mitral valve surgery is safe procedure with a reduced incidence of neurologic complications compared with retrograde perfusion strategy.