Comparison of Cannulation-Strategies for Minimally Invasive Mitral Valve Repair

Background: Mitral valve repair through a right anterolateral thoracotomy (MICS-MVR) is known to offer excellent results with noninferior perioperative outcomes compared with mitral valve repair performed through a median sternotomy. In terms of arterial cannulation for initiation of cardiopulmonary bypass (CPB), various strategies exist in MICS-MVR. Aim of this study was to examine the potential influence of different arterial cannulation-strategies on a binary adverse composite endpoint.

Methods: This is a retrospective data-analysis of 823 patients that underwent MICS-MVR through right-lateral thoracotomy. Three different arterial cannulation-strategies were used for initiation of cardiopulmonary bypass: direct aortic cannulation (DAC), groin-cut-down with open cannulation of the femoral artery (OFA), percutaneous cannulation of the femoral artery (PFA). Patients were investigated in relation to a primary composite-endpoint consisting of 30d-mortality, stroke, cannulation related conversion to sternotomy/re-thoracotomy, aortic or femoral vessel-dissection and infection of the cannulation-site. In a secondary analysis, retrograde perfusion was compared with DAC in terms of incidence of postoperative delirium. Standardized mean difference was used for adjusted intergroup comparisons, multivariable logistic regression models were used for risk-analysis.

Results: Between 01/2013 and 12/2019, 823 patients underwent MICS-MVR in the two participating study-centers. Mean age of the study group was 63 ± 13 years, 68% were male. In 266 (32.3%) patients DAC, 396 (48.1%) patients OFA and in 161 (19.6%) patients PFA was used for initiation of CPB. 10 (3.8%) patients reached the primary composite endpoint in the DAC, 35 (8.8%) in the OFA and 16 (9.9%) in the PFA group. Postoperative delirium occurred in 24 (9.0%) of the DAC, 54 (13.6%) of the OFA and 11 (6.8%) of the PFA group. DAC showed moderately significant lower odds for meeting the primary composite endpoint (OR 0.46 [0.21 - 0.94]; p = 0.04) as well as postoperative delirium (OR 0.51 [0.29 - 0.86]; p = 0.01) when compared with both types of femoral artery cannulation.

Conclusion: In MICS-MVR, direct aortic cannulation compared with femoral vessel cannulation for initiation of cardiopulmonary bypass is associated with less cannulation related complications and lower incidence of postoperative delirium.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024