Initial Experience with Fully Percutaneous Plug-Based Vascular Closure for Minimally Invasive Mitral Valve Surgery

Objectives: Surgical exposure of groin vessels to cannulate for minimally invasive mitral valve surgery (MIS) is standard of care but may result in wound healing disorders or seroma formation. The aim of this study was to analyze our single-center experience with fully percutaneous plug-based vascular closure device for MIS.

Methods: Between 03/2020 and 09/2020, MIS using the MANTA (Teleflex Medical Inc., Wayne, PA, USA) vascular closure device was performed in 20 patients (58.4 ± 11.7 years, 55% male, EuroSCORE II 1.1 ± 0.5%). Concomitant procedures were tricuspid valve repair, left atrial appendage occlusion and cryoablation for atrial fibrillation in 20% respectively. Surgical approach was a right anterolateral minithoracotomy. Cardiopulmonary bypass was established via fully percutaneous cannulation of femoral artery and vein. In 40% and 10% additional cannulation of the jugular vein and contralateral femoral vein were performed in heavy-built patients. Data were retrospectively analyzed in accordance with standardized M-VARC definitions, MANTA device success and early safety defined as occurrence of any access site or access-related vascular injury, major and life threatening bleeding complications.

Result: Mean aortic cross-clamp time and cardiopulmonary bypass were 94.7 ± 20.4 minutes and 148.2 ± 27.6 minutes, respectively. Mitral valve replacement was necessary in two patients. MANTA device success with immediate hemostasis and early safety were 95%. In one case, device failure due to user error necessitated surgical cutdown. Stroke, renal failure, or myocardial infarction was not observed. Intensive care unit and total hospital stay were 1.7 ± 0.8 days and 9.9 ± 6.2 days. Overall 30-day mortality was 0%. Postprocedure echocardiography showed competent mitral and tricuspid valves in all but one case of residual moderate tricuspid regurgitation.

Conclusion: This plug-based vascular closure device is safe and effective in MIS. Its ease of use and effectiveness to achieve immediate hemostasis has further simplified MIS.

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Artikel online veröffentlicht:
19. Februar 2021