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Published on: October 16, 2021
Antegrade axillary arterial perfusion in 3D endoscopic minimally-invasive mitral valve surgery
Johannes Petersen1, Shiho Naito1, Benjamin Kloth1,2
1Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany.
Background:
Minimally-invasive (MIS) mitral valve (MV) surgery has become standard therapy in many cardiac surgery centers. While femoral arterial perfusion is the preferred cannulation strategy in MIS mitral valve surgery, retrograde arterial perfusion is known to be associated with an increased risk for cerebral atheroembolism, particularly in atherosclerosis patients. Therefore, antegrade perfusion may be beneficial in such cases. This analysis aimed to compare outcomes of antegrade axillary vs. retrograde femoral perfusion in the MIS mitral valve surgery.
Methods:
This analysis includes 50 consecutive patients who underwent MIS between 2016 and 2020 using arterial cannulation of right axillary artery (Group A) due to severe aortic arteriosclerosis. Perioperative outcomes of the study group were compared with a historical control group of retrograde femoral perfusion (Group F) which was adjusted for age and gender (n = 50). Primary endpoint of the study was in-hospital mortality and perioperative cerebrovascular events.
Results:
Patients in group A had a significantly higher perioperative risk as compared to Group F (EuroSCORE II: 3.9 ± 2.5 vs. 1.6 ± 1.5; p = 0.001; STS-Score: 2.1 ± 1.4 vs. 1.3 ± 0.6; p = 0.023). Cardiopulmonary bypass time (group A: 172 ± 46; group F: 178 ± 51 min; p = 0.627) and duration of surgery (group A: 260 ± 65; group F: 257 ± 69 min; p = 0.870) were similar. However, aortic cross clamp time was significantly shorter in group A as compared to group F (86 ± 20 vs. 111 ± 29 min, p < 0.001). There was no perioperative stroke in either groups. In-hospital mortality was similar in both groups (group A: 1 patient; group F: 0 patients; p = 0.289). In group A, one patient required central aortic repair due to intraoperative aortic dissection. No further cardiovascular events occurred in Group A patients.
Conclusion:
Selective use of antegrade axillary artery perfusion in patients with systemic atherosclerosis shows similar in-hospital outcomes as compared to lower risk patients undergoing retrograde femoral perfusion. Patients with higher perioperative risk and severe atherosclerosis can be safely treated via the minimally invasive approach with antegrade axillary perfusion.
Insights
Antegrade axillary artery perfusion in minimally-invasive mitral valve surgery is safe for patients with atherosclerosis, showing similar outcomes to retrograde femoral perfusion despite higher initial risk. This approach allows safe treatment for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Arterial Perfusion
Background:
- Minimally-invasive (MIS) mitral valve (MV) surgery is a standard procedure.
- Retrograde arterial perfusion, often via the femoral artery, carries a risk of cerebral atheroembolism, especially in patients with atherosclerosis.
- Antegrade perfusion strategies may mitigate this risk.
Purpose of the Study:
- To compare outcomes of antegrade axillary artery perfusion versus retrograde femoral artery perfusion in MIS mitral valve surgery.
- To evaluate the safety and efficacy of antegrade axillary perfusion in patients with severe aortic arteriosclerosis.
Main Methods:
- A comparative analysis of 50 consecutive MIS mitral valve surgery patients using right axillary artery cannulation (Group A) due to severe aortic arteriosclerosis.
- Comparison with a historical control group (Group F) of 50 patients undergoing retrograde femoral perfusion, matched for age and gender.
- Primary endpoints included in-hospital mortality and perioperative cerebrovascular events.
Main Results:
- Group A patients had higher predicted perioperative risk (EuroSCORE II, STS-Score) but similar cardiopulmonary bypass and surgery durations compared to Group F.
- Aortic cross-clamp time was significantly shorter in Group A (86 ± 20 min) versus Group F (111 ± 29 min).
- No perioperative strokes occurred in either group; in-hospital mortality was similar (1 in Group A, 0 in Group F).
Conclusions:
- Selective antegrade axillary artery perfusion in MIS mitral valve surgery is a safe option for patients with systemic atherosclerosis.
- This approach demonstrates comparable in-hospital outcomes to retrograde femoral perfusion in lower-risk patients.
- Patients with higher perioperative risk and severe atherosclerosis can be safely managed with MIS and antegrade axillary perfusion.
