Percutaneous Peripheral Cannulation for Minimally Invasive Heart Valve Surgery: Results from the Multicenter Promise Registry

Background: Minimally invasive heart valve surgery (HVS) including cannulation of femoral vessels for is well-established standard of care at specialized centers. Percutaneous femoral cannulation has emerged as an alternative strategy to avoid potential groin incision associated infection or lymphocele formation. Different vascular closure devices (VCD) are available, but remain to be investigated.

Methods: Multicenter registry including 755 consecutive patients undergoing percutaneous access site closure using dedicated VCDs during minimally invasive HVS at 6 centers in Germany. Retrospective comparison of plug- (n = 450, group 1) or suture-based (n = 305, group 2) VCDs according to modified VARC-3 criteria.

Results: Median patient age (61.0 versus 62.7 years; p = 0.019), prevalence of hypertension (49.2 versus 58.6%; p = 0.024), COPD (3.4 versus 10.3%; p < 0.001), and atrial fibrillation (26.2 versus 34.1%; p = 0.024), as well as median STS Prom Score (0.4 versus 0.6; p < 0.001) and EURO SCORE II (0.7 versus 1.1; p < 0.001) were significantly lower in group 1. Frequency of preoperative assessment of femoral vessels was similar between groups (37.3 versus 33.9%; p = 0.37), while sonography-guided cannulation was less frequently performed in group 1 (33.6 versus 63.6%; p < 0.001). Of note, patients within both groups had a low prevalence of peripheral artery disease (3.8 versus 5.2%; p = 0.43) and received similarly sized femoral artery cannulas (p = 0.095). Immediate hemostasis was more often achieved in group 1 (99.8 versus 77.7%; p < 0.001). Use rate of a second VCD (0.2 versus 34.8%; p < 0.001) as well as conversion rates to surgical cut-down (1.3 versus 3.9%; p = 0.04) were significantly lower in group 1. Overall rates of minor vascular access site (VAS) related complications (lymphatic fistula [0 versus 0.7%; p = 0.32], arteriovenous fistula [0.4 versus 0%; p = 0.66], pseudoaneurysm formation [0.4 versus 0%; p = 0.66], postoperative VAS bleeding [2.2 versus 1.6%; p = 0.77]) were low in both groups (2.9 versus 5.2%; p = 0.14). Overall 30-day mortality was 0.8%.

Conclusion: Overall perioperative vascular access site related complications were favorably low in both groups. Patients in group 1 had significantly higher rates of immediate hemostasis and less need for an additional vascular closure device or surgical cut-down. Usage of dedicated vascular closure devices for vascular access site closure after percutaneous cannulation of femoral vessels is feasible and safe and may become standard of care to further decrease invasiveness in minimally invasive HVS.

NB: This abstract was presented in a similar form at a previous meeting.

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Artikel online veröffentlicht:
11. Februar 2025