Percutaneous vascular closure device in minimally invasive mitral valve surgery

Abstract Background Minimally invasive mitral valve surgery requires femoral artery cannulation for extracorporeal circulation, predominantly performed through surgical cut-down. 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 A single-center prospective study comparing patients undergoing minimally invasive mitral valve surgery with femoral cannulation performed either through surgical cut-down or percutaneously with access site closure using a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA). Results During 2016 to 2018 a total of 268 (147 surgical cut-down, 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 (VARC)-2 major access site vascular complications (overall cohort: 0 vs. 4.1%, p=0.013, propensity score-matched cohort: 0 vs. 4.6%, p=0.024). Bleeding did not occur in any group. In the overall series, surgical cut-down patients had a higher incidence of seroma (10.9% vs 0%, p Conclusions Percutaneous femoral artery cannulation using a novel plug-based VCD in minimally invasive mitral valve surgery eliminates traditional complications frequently seen with surgical cut-down with no femoral access site seroma and infection though at the expense of an increased risk for vascular complications.