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Efficacy Of Percutaneous Cannulation In Minimally Invasive Cardiac Surgery
Naohiro Wakabayashi1, Makoto Hashimoto
2.
1Sapporo Cardio-Vascular Clinic, Sapporo, Hokkaido, Japan,
2Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
BACKGROUND: Percutaneous cannulation for cardiopulmonary bypass (CPB) in minimally invasive cardiac surgery (MICS) has gradually become prevalent. The aim of the present study was to compare the outcomes of percutaneous approach with surgical cut-down approach and verify the efficacy and safety of vascular closure device.
METHODS: Between April 2019 and February 2024, excluded patients unsuitable for femoral cannulation such as narrow iliac and femoral vessels or atherosclerotic aorta, 313 consecutive patients underwent aortic valve replacement and mitral valve repair with MICS approach via femoral vessels cannulation at our institute. Percutaneous cannulation using vascular closure device (Perclose ProGlide system) was introduced in November 2021. Baseline characteristics, operative data and postoperative outcomes including complications or ICU / in-hospital stay were retrospectively analyzed.
RESULTS: Surgical cut-down approach was conducted in 126 patients (40.3%), whereas percutaneous approach was performed in 187 patients (59.7%). There was no significant distinction between the two groups in terms of baseline characteristics including age, sex, BSA, comorbidities, and surgical procedure. Operative time, cardiopulmonary bypass time, and aortic cross clamp time were significantly shorter in percutaneous group (p<0.05). While there was no patient suffered from vascular complication in percutaneous group, only one patient with surgical cut-down approach has minor vascular complication. Complications associated with groin cannulation site occurred in only one patient with surgical cut-down approach (5.6% vs 0%, p<0.01), and ICU stay of patients with percutaneous approach was shorter than patients with surgical cut-down approach (1.2 days vs 1.5 days, p<0.01). The peak creatine phosphorus kinase during postoperative period was significantly lower in percutaneous group (1106 U/L vs 1842 U/L, p<0.01).
CONCLUSIONS: Percutaneous femoral cannulation using vascular closure device provided the selected patients underwent MICS with less invasiveness without increased vascular complications.
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