Central vs Percutaneous Peripheral Femoral Venous Cannulation in Minimally Invasive Aortic Valve Replacement through Ministernotomy

Abstract

Background: Minimally invasive aortic valve replacement (MIAVR) through mini-sternotomy represents an evolving surgical technique in the management of valvular heart disease, and this study aims to compare central versus percutaneous peripheral femoral venous cannulation strategies in MIAVR with respect to surgical exposure, wound length, cardiopulmonary and ischemic times, and postoperative outcomes. Objective: to assess visibility and exposure of surgical field, wound length, in patients undergoing Minimally invasive aortic valve replacement (MIAVR) through mini-sternotomy. And to compare between central cannulation and percutaneous peripheral femoral venous cannulation in MIAVR through mini-sternotomy regarding total bypass time, ischemic time during cardiopulmonary bypass, hospital stay and postoperative complications. Patients and Methods: A prospective observational study included 30 patients who underwent MIAVR through mini-sternotomy at Cardiothoracic surgery department, Kasr Al Ainy Hospital between July 2024 and January 2025 were included and were divided into 2 groups according to their cannulation type: Group A: consists of 15 patients who were subjected to Central venous Cannulation. Group B: consists of 15 patients who were subjected to Peripheral venous cannulation. Results: Mean bypass time in studied patients was 102.87±14.2 minutes. Mean ischemic time was 80.27±13.7 minutes. Vacuum assisted drainage was needed in 33% of patients (5 patients) in peripheral venous cannulation group. Re-exploration was done among 6.7% of patients in both groups. Regarding mortality, we found that 1 patient (6.7%) of group A died while there were no recorded cases of postoperative mortality in Group B (P=0.483). Of the 15 patients that underwent central venous cannulation, 2 (13.3%) patients developed severe pericardial effusion. Patients subjected to central venous cannulation has a significantly longer incision when compared to patients in the peripheral venous cannulation group (9.8±0.98 vs 6.73 ±1.12 cm; P=0.003). Conclusion: Percutaneous peripheral femoral cannulation provides a safe alternative to central venous cannulation for cardiopulmonary bypass with a smaller incision length. When comparing central and femoral venous cannulation, we found no significant difference in the postoperative complication rates and overall mortality.