Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery.
Aged
Catheterization
/ adverse effects
Constriction, Pathologic
Equipment Design
Female
Femoral Artery
/ injuries
Humans
Intermittent Claudication
/ epidemiology
Male
Middle Aged
Minimally Invasive Surgical Procedures
Mitral Valve
/ surgery
Peripheral Nerve Injuries
/ epidemiology
Postoperative Complications
/ epidemiology
Prospective Studies
Seroma
/ epidemiology
Ultrasonography, Interventional
Vascular Closure Devices
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
24
06
2019
revised:
30
09
2019
accepted:
14
10
2019
pubmed:
4
12
2019
medline:
28
8
2020
entrez:
4
12
2019
Statut:
ppublish
Résumé
Minimally invasive mitral valve surgery requires femoral artery cannulation for extracorporeal circulation, predominantly performed through surgical cutdown. Surgical groin incision is frequently associated with complications such as seroma and infection. We evaluated the safety and efficacy of a percutaneous plug-based large-bore vascular closure device (VCD) for femoral artery closure in minimally invasive mitral valve surgery. This was a single-center prospective study comparing patients undergoing minimally invasive mitral valve surgery with femoral cannulation performed either through surgical cutdown or percutaneously with access site closure using a plug-based VCD (MANTA; Teleflex/Essential Medical, Malvern, PA). From 2016 to 2018, a total of 268 (147 surgical cutdown, 121 VCD) patients underwent minimally invasive mitral valve surgery with femoral arterial cannulation of catheters sized 19-F or 21-F. Propensity score matching resulted in 109 matched pairs. In both the overall series and the propensity-matched cohort, VCD patients had a significantly higher incidence of Valve Academic Research Consortium-2 major access site vascular complications (overall cohort: 0% vs 4.1%; P = .013; propensity score-matched cohort: 0% vs 4.6%; P = .024). Bleeding did not occur in any group. In the overall series, surgical cutdown patients had a higher incidence of seroma (10.9% vs 0%; P < .001). Infection and seroma did not occur in the VCD group. Percutaneous femoral artery cannulation using a novel plug-based VCD in minimally invasive mitral valve surgery eliminates traditional complications frequently seen with surgical cutdown with no femoral access site seroma and infection though at the expense of an increased risk for vascular complications.
Sections du résumé
BACKGROUND
Minimally invasive mitral valve surgery requires femoral artery cannulation for extracorporeal circulation, predominantly performed through surgical cutdown. Surgical groin incision is frequently associated with complications such as seroma and infection. We evaluated the safety and efficacy of a percutaneous plug-based large-bore vascular closure device (VCD) for femoral artery closure in minimally invasive mitral valve surgery.
METHODS
This was a single-center prospective study comparing patients undergoing minimally invasive mitral valve surgery with femoral cannulation performed either through surgical cutdown or percutaneously with access site closure using a plug-based VCD (MANTA; Teleflex/Essential Medical, Malvern, PA).
RESULTS
From 2016 to 2018, a total of 268 (147 surgical cutdown, 121 VCD) patients underwent minimally invasive mitral valve surgery with femoral arterial cannulation of catheters sized 19-F or 21-F. Propensity score matching resulted in 109 matched pairs. In both the overall series and the propensity-matched cohort, VCD patients had a significantly higher incidence of Valve Academic Research Consortium-2 major access site vascular complications (overall cohort: 0% vs 4.1%; P = .013; propensity score-matched cohort: 0% vs 4.6%; P = .024). Bleeding did not occur in any group. In the overall series, surgical cutdown patients had a higher incidence of seroma (10.9% vs 0%; P < .001). Infection and seroma did not occur in the VCD group.
CONCLUSIONS
Percutaneous femoral artery cannulation using a novel plug-based VCD in minimally invasive mitral valve surgery eliminates traditional complications frequently seen with surgical cutdown with no femoral access site seroma and infection though at the expense of an increased risk for vascular complications.
Identifiants
pubmed: 31794742
pii: S0003-4975(19)31826-0
doi: 10.1016/j.athoracsur.2019.10.038
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03697941']
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-91Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.