Acute Outcomes after Use of Vascular Closure Devices for Percutaneous Cannulation during Endoscopic Mitral Valve Surgery

Background: Extracorporeal circulation is conventionally established via surgical cutdown and direct cannulation of groin vessels for endoscopic mitral valve surgery (MVS). Surgical groin incision may result in postoperative wound healing disorder, infection, or seroma formation. Fully percutaneous cannulation of femoral vessels using a percutaneous plug-based large-bore vascular closure device (VCD) might represent a valuable alternative but remains to be investigated.

Methods: From 2018 to 2023, a total of 301 consecutive patients underwent endoscopic MVS via an anterolateral, limited skin incision and 3D-camera visualization at our institution. Percutaneous femoral cannulation was performed using an 18-Fr VCD in all patients. Acute perioperative outcome was retrospectively analyzed.

Results: Patients in this cohort had a median age of 59 years (±12.1 years) and the predominant gender was male (62.1%). A high proportion of patients reported mild symptoms (NYHA classes I–II, 62.2%) and showed a limited prevalence of comorbidities. The most common concomitant diseases were arterial hypertension (49.2%) and atrial fibrillation (32.9%). The overall risk profile was low with median STS-PROM Score of 0.42% (IQR 0.27–0.81%). Mitral valve repair and replacement were performed in 86.4% and 11.6% respectively. Most frequent concomitant procedures included left atrial appendage closure (28.2%), atrial fibrillation ablation (22.9%), and tricuspid valve repair (15.3%). Postoperative incidence of vascular access site complications was low. Despite achieving immediate hemostasis in all patients, three individuals (1%) experienced late postoperative femoral artery bleeding requiring endovascular intervention. Furthermore, formation of pseudo aneurysm and occlusion of the femoral artery occurred in two patients (0.7%) respectively. An arteriovenous fistula of the femoral artery developed in one patient (0.3%). No cases of lymphocele formation or groin infection occurred, resulting in an overall vascular access site complication rate of 2.7%. Patients were discharged from intensive care unit after a medium stay of 1 day (IQR 1–2.5) and total length of in-hospital stay was 7 days (IQR 6–10). Overall mortality was 0% at 30 days.

Conclusion: Use of this VCD for percutaneous femoral artery cannulation for endoscopic MVS is feasible and safe. Comparative analyses to conventional groin incision are underway.

Publication History

Article published online:
11 February 2025