Femoral vessel cannulation strategies in minimally invasive cardiac surgery: single Perclose ProGlide versus open cut-down†.

objectivesSurgical cut-down is commonly used for femoral cannulation in minimally invasive cardiac surgery, but is associated with higher rates of wound healing disorders. Percutaneous cannulation using vascular closure devices offers a less invasive alternative with potentially fewer complications. The aim of this study was to assess the feasibility and safety of using a single ProGlide system for primary access-site closure in comparison with surgical cut-down. Additionally, we analysed the learning curve for adopting this strategy.

methodsA retrospective analysis was conducted on 753 patients who underwent minimally invasive cardiac surgery at our centre between January 2018 and February 2024. Femoral access was achieved via open cut-down in 377 patients and percutaneous cannulation using a single ProGlide system in 376. The percutaneous cohort was categorized into 2 subgroups: early era (2020-2021, N = 102) versus late era (2022-2024, N = 274). The primary end-point was late access-site-related complications, while the secondary end-point was device failure requiring open femoral revision.

resultsAccess-site complications including lymph fistula, healing disorders were significantly higher in the open cut-down group compared to the percutaneous group (lymph fistula: 10.6% cut-down vs 0.3% percutaneous, P = 0.004, healing disorders: 3.4% cut-down vs 0% vascular closure device, P < 0.001). The success rate of a single vascular closure device strategy improved from 65.7% in the early era to 91.6% in the late era (P < 0.001), with fewer device failures (2.9% vs 11.7%; P = 0.001).

conclusionsPercutaneous cannulation using single ProGlide is observed as a safe and feasible alternative to open femoral cut-down and showed excellent results after an initial learning curve.