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

Abstract

OBJECTIVES: Surgical 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. METHODS: A 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. RESULTS: Access-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). CONCLUSIONS: Percutaneous 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.