Percutaneous Access for Cardiopulmonary Bypass Reduces Complication Rates in Minimally Invasive Cardiac Surgery

Background: Femoral cutdown is standard in most centers if groin cannulation is used for cardiopulmonary bypass (CPB) in minimally invasive cardiac surgery (MICS). Arterial closure devices (ACDs) allow placement of larger cannulas percutaneously, but its benefit in MICS is unclear. We assessed our results with ACDs in comparison with conventional surgical access in patients undergoing MICS.

Methods: We retrospectively evaluated 445 consecutive patients operated in our department in MICS between October 2010 and March 2015. Of those, 92 (21%) were performed with conventional surgical access to the groin vessels and 353 (79%) with the use of ACDs.

Results: Both groups showed similar preoperative characteristics except for a higher operative risk in the ACD group (EuroSCORE 7,9 ± 8,1 vs 10,6 ± 12,6; p = 0,01). Use of ACD significantly reduced the operation time (in minutes: 193,2 ± 43,8 vs 172,6 ± 47,1; p< 0,001). The incidence of complications was significantly lower in the ACD group (8,7% vs 2,3%; p = 0,007). Complications at the cannulation site consisted of lymphatic fistulae (n = 4, surgical), wound infections (n = 2; surgical), dissection (n = 2, ACD), stenosis (n = 3, ACD vs n = 1, surgical), aneurysm (n = 2, ACD) and hematoma (n = 1, surgical; n = 1, ACD). There were two vascular injuries, leading to conversion to surgical access. Use of ACD caused no difference in days-to-mobilization (1,9 ± 0,8 vs 2 ± 1,5; p = 0,8) although there was a trend toward longer hospital stay in the surgical group (13 ± 0,8 vs 11 ± 0,3; p = 0,051).

Conclusion: Use of ACDs was associated with vascular lesions while femoral cutdown was associated with complications of the surgical access. Our results indicate significant reduction in overall complication rates with the use of ACDs for percutaneous CPB.