title: Comparison of direct aortic and femoral cannulation for port-access cardiac operations.
abstract: BACKGROUND
  Differences in outcome after direct aortic cannulation (AORT) in the chest versus standard femoral arterial cannulation (FEM) have not been defined for minimally invasive cardiac operations utilizing the port-access approach.
  
  
  METHODS
  A retrospective study was performed of 165 patients undergoing port-access cardiac mitral valve operation (n = 126) or coronary artery bypass grafting (n = 39). In 113 patients, FEM was used, while in 52 patients, AORT was accomplished through a port in the first intercostal space.
  
  
  RESULTS
  AORT eliminated endoaortic balloon clamp migration (0/36 [0%] vs. 17/95 [18%]), and groin wound or femoral arterial complications (0/52 [0%] vs. 11/113 [10%]) without changing procedure times (363+/-55 vs. 355+/-70 minutes). Complications attributable to AORT were injury to the right internal mammary artery and aortic cannulation site bleeding in 1 patient each.
  
  
  CONCLUSIONS
  Direct aortic cannulation is technically easy, allows use of an endoaortic clamp, and avoids aorto-iliac arterial disease, the groin incision, and possible femoral arterial injury associated with femoral arterial cannulation. Direct arterial cannulation should expand the pool of patients eligible for port-access operation, and may become the standard for port-access procedures.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. glowe001@mc.duke.edu
authors.forename: D D
authors.initials: DD
authors.lastname: Glower
authors.forename: F M
authors.initials: FM
authors.lastname: Clements
authors.forename: N P
authors.initials: NP
authors.lastname: Debruijn
authors.forename: M
authors.initials: M
authors.lastname: Stafford-Smith
authors.forename: R D
authors.initials: RD
authors.lastname: Davis
authors.forename: K P
authors.initials: KP
authors.lastname: Landolfo
authors.forename: P K
authors.initials: PK
authors.lastname: Smith
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic; D002404:Catheterization / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D008943:Mitral Valve / Q000601:surgery*; D011677:Punctures / Q000295:instrumentation; D016896:Treatment Outcome