Comparison of cannulation strategies for minimally invasive mitral valve surgery

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ID: 319501
2026
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Abstract
OBJECTIVES: Minimally invasive mitral valve surgery (MIV-MVS) continues to evolve through refinements in surgical technique and perioperative management. This study evaluated the association between arterial cannulation strategy and perioperative adverse events. METHODS: Three arterial cannulations were used: central ascending aortic cannulation (AC), open femoral cannulation via groin-cutdown (oFC), and percutaneous femoral cannulation (pFC) using pre-closure devices. Patients from two centres were assessed for the composite safety end-point of 30-day mortality or stroke, the composite efficacy end-point of all-cause death, stroke, or cannulation-related adverse events, and postoperative delirium. Cannulation-related adverse events included conversion to sternotomy or re-thoracotomy, vessel dissection or bleeding, and cannulation-site infection. RESULTS: Between January 2013 and January 2020, 823 patients underwent MIV-MVS. AC was performed in 266 patients (32.3%), oFC in 396 (48.1%), and pFC in 161 (19.6%). The composite end-point of 30-day all-cause death or stroke occurred in 19 patients (2.3%) and was similar between AC and FC (OR 1.16, 95% CI 0.41-3.16). The extended composite efficacy end-point occurred less frequently with AC than with any FC (OR 0.46, 95% CI 0.21-0.94), mainly due to fewer access-site complications. AC was also associated with lower odds of perioperative delirium (OR 0.51, 95% CI 0.29-0.86). No significant difference was observed between oFC and pFC. CONCLUSIONS: In patients undergoing MIV-MVS, 30-day death or stroke was similar across cannulation strategies. AC was associated with a lower rate of cannulation-related complications and less perioperative delirium than femoral cannulation, largely reflecting fewer access-site complications. Further prospective external validation is warranted.
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Authors Juri Sromicki, Nestoras Papadopoulos, Lisa Tröbinger, Vasileios Ntinopoulos, Monika Hebeisen, M Milojević, Héctor Rodríguez Cetina Biefer, Omer Dzemali
Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag185
URL
https://doi.org/10.1093/icvts/ivag185
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