Antegrade Versus Retrograde Arterial Cannulation In Minimally Invasive Aortic Valve Replacement: A Propensity-score Analysis Of Early Outcomes
Claudio Muneretto, Laura Giroletti, Lorenzo Di Bacco, Alberto Repossini, Gianluigi Bisleri.
University of Brescia Medical School, Brescia, Italy.
OBJECTIVE: Despite the growing popularity of minimally invasive approaches for aortic valve replacement(MI-AVR), recently there have been concerns about the use of retrograde arterial flow and femoral artery cannulation during such procedures due to a potentially increased risk for iatrogenic complications.
METHODS: Among 642 consecutive patients undergoing MI-AVR, a propensity-score analysis was performed among those patients receiving a conventional arterial cannulation in the ascending aorta(Group1, G1=121 pts) versus retrograde arterial perfusion via femoral artery cannulation (G2, G2=121 pts); of note, in all patients of G1 arterial cannulation was performed with a seldinger technique and CPB flow was established by means of a centrifugal pump. Patients were matched according to the following criteria: age, female sex, BMI, hypertension, peripheral vascular disease, diabetes, chronic renal failure, type of prosthesis (biological or mechanical).
Early outcome was evaluated in terms of postoperative occurrence of stroke/TIAs(primary end-point) as well as incidence of iatrogenic aortic dissection and hospital mortality(secondary end-points).
RESULTS: The incidence of perioperative stroke(G1= 0% vs G2= 0.8%, p=1.0) and TIAs(G1= 0% vs G2= 0%, p=1.0) was comparable across the study population. Iatrogenic aortic dissection did not occur in any patients of both groups and hospital mortality was also similar(G1= 0.8% vs G2= 1.7%, p=0.62). Moreover, femoral vessel complications at the cannulation site such as ischemia/dissection, nerve injury and inguinal lymphorrea occurred in 0%, in 1.7%(2 pts) and 0,8% ( 1 pts).
CONCLUSIONS: Minimally invasive aortic valve replacement can be safely performed by means of either an antegrade or retrograde arterial flow with similar early clinical outcomes. The use of peripheral arterial cannulation may enhance the feasibility of minimally invasive procedures while reducing the drawbacks of central cannulation through a limited access.
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