Percutaneous Cannulation for Minimally Invasive Heart Valve Surgery: Results from a Multicenter Registry.

Abstract

Objective: To avoid potential groin incision associated complications and further streamline surgery percutaneous femoral cannulation using different vascular closure devices (VCDs) has emerged to establish cardiopulmonary bypass during minimally invasive heart valve surgery (HVS).

Design: The Percutaneous peRipheral cannulatiOn for Minimally InvaSive heart valve surgEry (PROMISE) multicentre registry included patients, receiving percutaneous vascular access site (VAS) closure during minimally invasive HVS. Retrospective analyses were performed to evaluate major and minor VAS-related complications of plug- (group 1) vs suture-based (group 2) systems according to modified Valve Academic Research Consortium (VARC) 3 criteria (ie, retrograde dissection, vascular injury, conversion to surgical cut-down, or vascular intervention).

Results: In total, 755 patients (66.1% (499/755) male; median age 61.9 years) were included and treated using a plug- (n = 450) or suture-based (n = 305) VCD. Most prevalent comorbidities were hypertension (53.8%; 335/755) and atrial fibrillation (29.4%; 222/755), resulting in a median STS Prom Score of 0.5%. Prevalence of peripheral artery disease was 4.4% (33/450). Immediate hemostasis was significantly higher in the plug-based group (99.8% (445/450) vs 77.7% (237/305); P < .001). Accordingly, application of a second VCD (0.0% (0/450) vs 34.8% (106/305); P < .001) as well as conversion rates to surgical cut-down (1.3% (6/450) vs 3.9% (12/305); P = .04) were significantly lower. Prevalence of VAS-related complications (ie, arterio-venous (AV) fistula (0.2% (1/450) vs 0% (0/305); P > .99), pseudoaneurysm (0.4% (2/450) vs 0% (0/305); P = .66), or postoperative VAS bleeding (1.6% (7/450) vs 0.7% (2/305); P = .26)) was low in both the groups (2.9% (13/450) vs 5.2% (16/305); P = .14).

Conclusions: VAS-related complications were favourably low in both the groups. Plug-based VCDs are potentially associated with significantly higher rates of immediate hemostasis and lower incidence for additional VCD or surgical cut-down. Usage of dedicated VCD (plug- and suture-based) for VAS closure after percutaneous cannulation is feasible, safe, and further decreases invasiveness in minimally invasive HVS.