Percutaneous Cannulation of Femoral Vessels in Minimally Invasive Cardiac Surgery

Abstract

Objective Despite the recent trend of access miniaturization in minimally invasive cardiac surgery (MICS) surgical “cut down (CD)” for femoral cannulation remains the standard at many centers. Percutaneous vascular closure (PVC) devices have recently been introduced for minimizing invasiveness during interventional diagnostic and therapy. This report summarizes the initial experience with this new approach in the setting of MICS, with a special focus on safety and advantages.

Methods Percutaneous cannulation with a standard protocol including preoperative computer tomography imaging and intraoperative point-of-care ultrasound guidance was performed in 93 consecutive patients from September 2018 until February 2020, while conventional “CD” procedure performed in 218 patients in the previous period. We analyzed patients' characteristics and compared access site complications of PVC group versus conventional “CD” group.

Results As far as operative/postoperative outcome, the duration of intensive care unit stay as well as hospital stay was statistically shorter in PVC compared with CD (CD vs. PVC: 2.74 ± 3.83 vs. 2.16 ± 2.01 days, p < 0.01, 16.7 ± 8.75 vs. 13.0 ± 4.96 days, p < 0.001, respectively). Further, we found no femoral infection or lymphocele in the PVC group, whereas 4 cases of wound complications were observed in the CD group.

Conclusion According to our results, percutaneous closure system for femoral vessels in MICS seems to be beneficial with the assist of preoperative computed tomography and intraoperative Doppler guidance.

Keywords

minimally invasive cardiac surgery - mitral valve surgery - femoral cannulation - percutaneous vascular closure - ProGlide

Authors' Contribution

Y.S. contributed to Data curation, investigation, formal analysis, writing of original draft, methodology, writing – review and editing, visualization. H.J. contributed to Data curation, investigation, formal analysis and methodology. M.B.I. and J.P.M. contributed to Data curation, investigation, writing – review and editing. S.K. contributed to Data curation, investigation, formal analysis and writing – review and editing. A.L. contributed to writing – review and editing, supervision, conceptualization and resources. P.A. contributed to methodology, writing – review and editing, visualization, supervision, conceptualization, resources and software.

Meeting Presentation

The EACTS 35th Annual Meeting.

Publikationsverlauf

Eingereicht: 24. Oktober 2021

Angenommen: 18. Februar 2022

Artikel online veröffentlicht:
27. Juli 2022

• References

• 1 Gupta A, Fouad L, Basir M. et al. Safety and effectiveness of MANTA vascular closure device after large-bore mechanical circulatory support: Real-world experience. Cardiovasc Revasc Med 2020; 21 (07) 875-878
• 2 Abdelaziz HK, Megaly M, Debski M. et al. Meta-analysis comparing percutaneous to surgical access in trans-femoral transcatheter aortic valve implantation. Am J Cardiol 2020; 125 (08) 1239-1248
• 3 Moriyama N, Lindström L, Laine M. Propensity-matched comparison of vascular closure devices after transcatheter aortic valve replacement using MANTA versus ProGlide. EuroIntervention 2019; 14 (15) e1558-e1565
• 4 Steppich B, Stegmüller F, Rumpf PM. et al. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device. J Interv Cardiol 2018; 31 (02) 223-229
• 5 Honda Y, Araki M, Yamawaki M. et al. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation. J Interv Cardiol 2018; 31 (02) 216-222
• 6 Hoffmann P, Al-Ani A, von Lueder T. et al. Access site complications after transfemoral aortic valve implantation - a comparison of Manta and ProGlide. CVIR Endovasc 2018; 1 (01) 20
• 7 Biancari F, Romppanen H, Savontaus M. et al. MANTA versus ProGlide vascular closure devices in transfemoral transcatheter aortic valve implantation. Int J Cardiol 2018; 263: 29-31
• 8 Kodama A, Yamamoto M, Shimura T. et al. Comparative data of single versus double ProGlide vascular preclose technique after percutaneous transfemoral transcatheter aortic valve implantation from the optimized catheter valvular intervention (OCEAN-TAVI) Japanese multicenter registry. Catheter Cardiovasc Interv 2017; 90 (03) E55-E62
• 9 Kawashima H, Watanabe Y, Kozuma K. et al. Propensity-matched comparison of percutaneous and surgical cut-down approaches in transfemoral transcatheter aortic valve implantation using a balloon-expandable valve. EuroIntervention 2017; 12 (16) 1954-1961
• 10 Cao Z, Wu W, Zhao K. et al. Safety and efficacy of totally percutaneous access compared with open femoral exposure for endovascular aneurysm repair: a meta-analysis. J Endovasc Ther 2017; 24 (02) 246-253
• 11 Lamelas J, Williams RF, Mawad M, LaPietra A. Complications associated with femoral cannulation during minimally invasive cardiac surgery. Ann Thorac Surg 2017; 103 (06) 1927-1932
• 12 Xu X, Liu Z, Han P. et al. Feasibility and safety of total percutaneous closure of femoral arterial access sites after veno-arterial extracorporeal membrane oxygenation. Medicine (Baltimore) 2019; 98 (45) e17910
• 13 Hwang JW, Yang JH, Sung K. et al. Percutaneous removal using Perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. J Vasc Surg 2016; 63 (04) 998-1003.e1
• 14 Pozzi M, Henaine R, Grinberg D. et al. Total percutaneous femoral vessels cannulation for minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013; 2 (06) 739-743
• 15 Kastengren M, Svenarud P, Kallner G. et al. Percutaneous vascular closure device in minimally invasive mitral valve surgery. Ann Thorac Surg 2019; 110 (01) 85-91
• 16 Immohr MB, Sugimura Y, Kröpil P. et al. Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery. J Cardiothorac Surg 2021; 16 (01) 34
• 17 Gao H, Luo M, Fang K. et al. Cumulative sum analysis of the learning curve for the preclosure technique using Proglide. Interact Cardiovasc Thorac Surg 2020; 30 (02) 280-286
• 18 Chen IM, Lee TH, Chen PL, Shih CC, Chang HH. Factors in ProGlide® vascular closure failure in sheath arteriotomies greater than 16 French. Eur J Vasc Endovasc Surg 2019; 58 (04) 615-622
• 19 Lin SY, Lyu SY, Su TW. et al. Predictive factors for additional ProGlide deployment in percutaneous endovascular aortic repair. J Vasc Interv Radiol 2017; 28 (04) 570-575
• 20 Abdel-Wahab M, Hartung P, Dumpies O. et al. Comparison of a pure plug-based versus a primary suture-based vascular closure device strategy for transfemoral transcatheter aortic valve replacement: the CHOICE-CLOSURE randomized clinical trial. Circulation 2022; 145 (03) 170-183