Novel Percutaneous Plug-Based Vascular Closure Device for Minimally Invasive Valve Surgery: From Initial Experience to Routine Use

Background: Minimally invasive valve surgery (MIS) requires surgical exposure of groin vessels to cannulate for cardiopulmonary bypass (CPB). Surgical groin incision may result in complications such as wound healing disorders or seroma formation. Therefore, percutaneous cannulation for CPB may improve clinical results. We herein assessed our single center experience with fully percutaneous plug-based vascular closure device for MIS.

Method: Between 03/2020 and 07/2021, a total of 60 patients (59.6 ± 13.6 years, 56% male, EuroSCORE II 1.4 ± 1.0%) underwent MIS using the MANTA (Teleflex Medical Inc., Wayne, PA, United States) vascular closure device. Procedures performed were isolated mitral valve repair in 70% (42/60), isolated mitral valve replacement in 6.6% (4/60), isolated tricuspid valve repair in 3.4% (2/60) or concomitant mitral valve and tricuspid surgery in 20% (12/60). Further concomitant procedures were left atrial appendage occlusion and cryoablation for atrial fibrillation in 21.6% (13/60) and 11.6% (7/60) respectively. Surgical approach was endoscopic via right anterolateral minithoracotomy. CPB was established via fully percutaneous cannulation of femoral artery and vein. In 50% and 5% 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.

Results: Mean aortic cross-clamp and cardiopulmonary bypass times were 94.6 ± 24.8 minute and 153.1 ± 36.7 minutes, respectively. MANTA device success with immediate hemostasis and early safety was 98.3% (59/60). In one case, device failure due to user error necessitated surgical cutdown. Stroke, renal failure, and myocardial infarction were not observed. Intensive care unit and total hospital stay were 1.9 ± 1.3 days and 10.7 ± 5.8 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: Percutaneous cannulation of femoral artery utilizing fully plug-based vascular closure device is safe and effective in MIS. Its ease of use and effectiveness has simplified MIS and have become our default approach.

Publication History

Article published online:
03 February 2022