Percutaneous versus surgical femoral access in minimally invasive cardiac operations

Abstract

OBJECTIVES Both surgical and percutaneous femoral accesses for the establishment of extracorporeal circulation are used in minimally invasive cardiac surgeries. The goal of this study was to compare the outcomes with the MANTA vascular closure device after percutaneous arterial decannulation via the surgical approach. METHODS Between November 2018 and January 2021, a total of 490 consecutive patients underwent minimally invasive cardiac operations at our institution. Cannulation and decannulation of femoral vessels were under direct vision surgically or percutaneously. The MANTA system was used to close the femoral artery in all patients with percutaneous cannulation. Demographic, clinical and procedural data were collected retrospectively. RESULTS Surgical cut-down and suture closure of the femoral artery was performed in 222 patients (45.3%); percutaneous access and closure with the MANTA system was used in 268 patients (54.7%). The surgical group presented a significantly higher incidence of any access site complication compared to the percutaneous group [18 patients (8.1%) vs 6 patients (2.2%); P = 0.003]. Lymph fistula and wound healing disorders occurred more frequently in the surgical group (3.2% vs 0% [P = 0.004] and 3.6% vs 0% [P = 0.002], respectively). Median procedural duration and stays in the intensive care unit were significantly lower in the percutaneous group {127 [interquartile range (IQR) 97–158] min vs 150 (IQR 117–185) min (P < 0.001) and 1 (IQR 1–2) day vs 2 (IQR 1–3) days (P = 0.008), respectively}. CONCLUSIONS Percutaneous access and closure with the MANTA system are feasible, safe and associated with lower incidences of all-cause access site complications and shorter stays in the intensive care unit compared to surgical access and closure in minimally invasive cardiac surgeries.

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 ).…”

µAVR: Endoscopic Microinvasive Aortic Valve Surgery With Automated Suturing Technology for Enhanced Patient Outcomes

“…6,7 The advantages of minimally invasive, and now microinvasive, approaches to cardiac surgeries are, among others, shorter intensive care unit and in-hospital stays, fewer blood transfusion requirements, early mobilization and return to normal function, better cosmetic results, and a potential for lower overall health care costs. 2,5,7,8 Despite the demonstrated advantages, alternatives to the median sternotomy access have yet to achieve widespread adoption. The early perception regarding minimally invasive cardiac surgical techniques was often associated with a steep learning curve, narrow field of vision, and tight working spaces, along with longer CPB and aortic cross-clamping durations; such potential risk for patients can be ameliorated with advanced technology and techniques.…”

“…As we previously published, the femoral artery is closed using the MANTA ® (Teleflex ® , Morrisville, NC, USA) vascular closure device. 5…”

Percutaneous versus open surgical cannulation for minimal invasive cardiac surgery; immediate postprocedural outcome analysis

“…Several other centers have started using ACD in MICS to minimize groin complications following the procedure. 5 , 9 , 10 Svenarud and colleagues 9 describes the technique for ACD using MANTA plug-based ACD only. Similarly, El-Sayed Ahmad and colleagues 10 reported a positive outcome in 268 patients who underwent MICS using the MANTA device without major complications.…”

“… 5 , 9 , 10 Svenarud and colleagues 9 describes the technique for ACD using MANTA plug-based ACD only. Similarly, El-Sayed Ahmad and colleagues 10 reported a positive outcome in 268 patients who underwent MICS using the MANTA device without major complications. In that study, the median procedural duration and stays in the intensive care unit were significantly lower in the percutaneous group.…”