Comparison of direct aortic and femoral cannulation for port-access cardiac operations

• Published in: The Annals of thoracic surgery Vol. 68; no. 4; pp. 1529 - 1531
• Main Authors: Glower, Donald D, Clements, Fiona M, Debruijn, Norbert P, Stafford-Smith, Mark, Davis, R.Duane, Landolfo, Kevin P, Smith, Peter K
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.1999; Elsevier Science
• Subjects: Adult; Aorta, Thoracic; Biological and medical sciences; Catheterization - instrumentation; Coronary Artery Bypass - instrumentation; Equipment Safety; Female; Femoral Artery; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - instrumentation; Humans; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - instrumentation; Mitral Valve - surgery; Punctures - instrumentation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Human; Femoral artery; Cardiovascular disease; Cannulation; Replacement; Coronary heart disease; Treatment; Aortocoronary; Cardiac valvular disease; Bypass; Surgery; Aorta; Surgical approach; Technique; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)00950-9

Background. Differences in outcome after direct aortic cannulation (AORT) in the chest versus standard femoral arterial cannulation (FEM) have not been defined for minimally invasive cardiac operations utilizing the port-access approach. Methods. A retrospective study was performed of 165 patients undergoing port-access cardiac mitral valve operation (n = 126) or coronary artery bypass grafting (n = 39). In 113 patients, FEM was used, while in 52 patients, AORT was accomplished through a port in the first intercostal space. Results. AORT eliminated endoaortic balloon clamp migration (0/36 [0%] vs 17/95 [18%]), and groin wound or femoral arterial complications (0/52 [0%] vs 11/113 [10%]) without changing procedure times (363 ± 55 vs 355 ± 70 minutes). Complications attributable to AORT were injury to the right internal mammary artery and aortic cannulation site bleeding in 1 patient each. Conclusions. Direct aortic cannulation is technically easy, allows use of an endoaortic clamp, and avoids aorto-iliac arterial disease, the groin incision, and possible femoral arterial injury associated with femoral arterial cannulation. Direct arterial cannulation should expand the pool of patients eligible for port-access operation, and may become the standard for port-access procedures.