First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery

Abstract

Background To more minimize the minimally invasive valve surgeries, percutaneous vascular access and closure has been used for the establishment of extracorporeal circulation. This study investigates early clinical outcomes of patients who received MANTA for femoral artery closure as first experiences in minimally invasive valve surgery. Methods Between January 2019 and July 2019, 103 consecutive patients (mean age: 58 ± 11 years) underwent video-assisted minimally invasive valve surgery through right anterior minithoracotomy at two cardiac surgery referral centers in Germany. Percutaneous cannulation for cardiopulmonary bypass and femoral artery closure with MANTA were performed in all patients: 18-F and 14-F MANTA were used in 88 (85.4%) and 15 (14.6%) patient, respectively. Mitral, aortic, tricuspid, and double valve surgeries were performed in 51 (49.5%), 39 (37.9%), 7 (6.8%), and 6 (5.8%), patients, respectively. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time and cross-clamping time were 69 ± 23 and 38 ± 14 minutes, respectively. Except for two patients with late pseudoaneurysm on 15th and 23th postoperative day, neither major nor minor vascular complications nor vascular closure device failure according to the Valve Academic Research Consortium-2 definition criteria was observed. Additionally, no wound healing disorders or conversion to surgical closure was observed. Conclusions MANTA as percutaneous femoral artery closure after decannulation of cardiopulmonary bypass is a safe, feasible, and effective approach and yields excellent early outcomes. Larger size studies are needed to evaluate more the efficacy and safety of MANTA.

A Novel Plug-Based Vascular Closure Device for Percutaneous Femoral Artery Closure in Patients Undergoing Minimally-Invasive Valve Surgery

“…An earlier study suggested a higher rate of VARC-2 adjudicated vascular complications with the MANTA device compared to surgical cutdown ( 21 ). However, in this series no postoperative vessel complications in terms of bleeding, wound healing disorders/seroma formation or pseudoaneurysms were seen during 30-days follow-up, which was also seen in a previous study ( 22 ) and which further corroborates the assumption that the MANTA™ device has the potential to simplify MIS valve surgery and to reduce intra- and postoperative vessel complications. It has to be emphasized that results of the MANTA device in TAVI differ significantly, most likely due to a significant older patient population with small and/or calcified iliac vessels ( 23 , 24 ).…”

Lessons learned from 10 years of experience with minimally invasive cardiac surgery

“…After 50 cases, ultrasound-guided percutaneous femoral cannulation for CPB can be used in combination with the use of MANTA™ VCD to avoid surgical complications of the groin. Our experience with MANTA TM system demonstrates this tool to be an effective, fast, and safe device, which also has a positive effect on the operating time compared to the surgical access for CPB in endoscopic MICS ( 9 , 10 ).…”

“…Severe calcification of the abdominal and/or thoracal aorta Severe kinking in the aorta Femoral or abdominal/thoracal aortic stent/prosthesis Groin infection (VCD) (Essential Medical, Inc., Malvern, PA, USA) is used in MICS. It serves as an elegant, safe, and reproducible closure device to manage this small bore access by immediate sealing (9). Otherwise, suture-based vascular closure devices, such as Perclose ProGlide and ProStar XL (Abbott Vascular, Santa Clara, CA, USA), are readily used for the closure of large bore access.…”

“…While in the conventional open surgical approach, the common femoral artery is directly sutured under direct vision after decannulation, the percutaneous innovative collagen-based MANTA™ Vascular Closure Device (VCD) (Essential Medical, Inc., Malvern, PA, USA) is used in MICS. It serves as an elegant, safe, and reproducible closure device to manage this small bore access by immediate sealing ( 9 ). Otherwise, suture-based vascular closure devices, such as Perclose ProGlide and ProStar XL (Abbott Vascular, Santa Clara, CA, USA), are readily used for the closure of large bore access.…”

Early Outcomes of Endoscopic Papillary Muscle Relocation for Secondary Mitral Regurgitation Type IIIb in Patients With Severe Left Ventricular Dysfunction

“… 22 , 23 In addition, all further surgical interventions that might be required due to advancing HF (i.e., LVAD implantation, heart transplantation) are technically less challenging after previous minimally invasive surgery as compared to conventional sternotomy. Furthermore, due to the implementation of enhanced recovery after cardiac surgery protocols, 24 as well as the adaption of advanced percutaneous cannulation techniques, 25 perioperative complication rates after minimally invasive MV surgery will potentially further decrease.…”