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First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery
13 February 2020 (online)
Objectives: To minimize more the minimally invasive valve surgeries, percutaneous vascular access and closure has been used for establishment of extracorporeal circulation. The current 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, a total of 103 consecutive patients (mean age: 58 ± 11 years, BMI: 25.3 ± 4.1) underwent video-assisted minimally invasive valve surgery through right anterior minithoracotomy at two cardiac surgery referral centers in Germany. Percutaneous cannulation for CPB 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 (14.5%) patients, respectively. Mitral-, aortic-, tricuspid, and double-valve surgeries were performed in 51 (49.5%), 39 (37.8%), 7 (6.8%), and 6 (5.8%) patients, respectively. Arterial hypertension, diabetes mellitus, and peripheral vascular disease represented in 61.1, 36.8, and 21.3% of 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, respectively. Intensive care stay and hospital stay were 2 ± 2 and 7 ± 4 days, respectively. Except in two patients with late pseudoaneurysm on 15th and 23th postoperative day, no dissection of femoral artery, no bleeding, no occlusion or flow limiting of peripheral artery, no wound healing disorders, no conversion to surgical closure, no nerve injury, and no lymphatic fistula were noted.
Conclusion: The usage of MANTA as percutaneous femoral artery closure after decannulation of cardiopulmonary bypass is a safe, feasible, and effective approach and yield excellent early outcomes. Larger size studies are needed to evaluate efficacy and safety of MANTA.