Comparison of cannulation strategies for minimally invasive mitral valve surgery
Juri Sromicki, Nestoras Papadopoulos, Lisa Tröbinger, Vasileios Ntinopoulos, Monika Hebeisen, Milan Milojevic, Hector Rodriguez Cetina Biefer, Omer DzemaliAbstract
OBJECTIVES
Minimally invasive mitral valve surgery (MIV-MVS) continues to evolve through refinements in surgical technique and perioperative management. This study evaluated the association between arterial cannulation strategy and perioperative adverse events.
METHODS
Three arterial cannulations were used: central ascending aortic cannulation (AC), open femoral cannulation via groin-cutdown (oFC), and percutaneous femoral cannulation (pFC) using pre-closure devices. Patients from two centres were assessed for the composite safety end-point of 30-day mortality or stroke, the composite efficacy end-point of all-cause death, stroke, or cannulation-related adverse events, and postoperative delirium. Cannulation-related adverse events included conversion to sternotomy or re-thoracotomy, vessel dissection or bleeding, and cannulation-site infection.
RESULTS
Between January 2013 and January 2020, 823 patients underwent MIV-MVS. AC was performed in 266 patients (32.3%), oFC in 396 (48.1%), and pFC in 161 (19.6%). The composite end-point of 30-day all-cause death or stroke occurred in 19 patients (2.3%) and was similar between AC and FC (OR 1.16, 95% CI 0.41–3.16). The extended composite efficacy end-point occurred less frequently with AC than with any FC (OR 0.46, 95% CI 0.21–0.94), mainly due to fewer access-site complications. AC was also associated with lower odds of perioperative delirium (OR 0.51, 95% CI 0.29–0.86). No significant difference was observed between oFC and pFC.
CONCLUSIONS
In patients undergoing MIV-MVS, 30-day death or stroke was similar across cannulation strategies. AC was associated with a lower rate of cannulation-related complications and less perioperative delirium than femoral cannulation, largely reflecting fewer access-site complications. Further prospective external validation is warranted.