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Network Meta-analysis Of Axillary, Femoral, And Central Cannulation Strategies In Minimally Invasive Cardiac Surgery Outcomes
Maria Comanici, Abu A. Farmidi, Gurkan Ayaz, Anton Sabashnikov, Sunil K. Bhudia, Shahzad G. Raja.
Harefield Hospital, London, United Kingdom.
Introduction The optimal arterial cannulation strategy in minimally invasive cardiac surgery (MICS) remains uncertain, with each approach—axillary, femoral, and central—presenting unique benefits and risks. Despite the growing interest in alternative cannulation sites, reflected in ongoing studies like the FAMI trial, no comprehensive network meta-analysis has previously compared all three techniques. This study provides the first network meta-analysis evaluating the impact of these strategies on mortality and stroke, offering innovative insights for clinical decision-making.
Methods A network meta-analysis was conducted, synthesizing evidence from studies directly or indirectly comparing axillary, femoral, and central cannulation in MICS. Mortality and stroke outcomes were analysed using pooled data, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. The analysis integrated direct and indirect comparisons to provide a robust, hierarchical assessment of all three strategies.
Results Eleven studies, including 10,216 participants, were analysed. Axillary cannulation was associated with a threefold higher odds of mortality compared to femoral cannulation (OR: 3.06; 95% CI: 0.12-76.95) and a ninefold higher odds of stroke (OR: 9.39; 95% CI: 0.45-197.52), though these findings were limited by small sample sizes. Central cannulation demonstrated significantly lower odds of mortality (OR: 2.42; 95% CI: 1.76-3.31) and stroke (OR: 3.19; 95% CI: 2.10-4.84) compared to femoral cannulation. Limited data for axillary versus central comparisons suggested slightly higher odds of mortality with axillary cannulation (OR: 1.28; 95% CI: 0.35-4.67), while stroke outcomes could not be estimated.
ConclusionThis meta-analysis underscores the importance of cannulation strategy in MICS, with central cannulation demonstrating consistent benefits over femoral cannulation in reducing mortality and stroke. Axillary cannulation shows potential but requires further robust evidence, as ongoing trials like the FAMI trial aim to address existing knowledge gaps.
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