title: Femoral cannulation: a safe vascular access option for cardiopulmonary bypass in minimally invasive cardiac surgery.
abstract: Femoral cannulation during cardiopulmonary bypass has become a common approach for many cardiac procedures and serves as an important access option, especially during minimally invasive cardiac surgery. Opponents, however, argue that there is significant risk, including site-specific and overall morbidity, which makes the use of this modality dangerous compared to conventional aortoatrial cannulation techniques. We analyzed our institutional experience to elucidate the safety and efficacy of femoral cannulation. All data were collected from a single hospital's cardiac surgery database. A total of 346 cardiac surgeries were evaluated from September 2012 to September 2013, of which 85/346 (24.6%) utilized a minimally invasive approach. Of the 346 operations performed, 72/346 (20.8%) utilized femoral cannulation while 274/346 (79.2%) used aortoatrial cannulation. Stroke occurred in 1/72 (1.39%) after femoral cannulation, specifically, in a conventional sternotomy patient, while it occurred in 6/274 (2.19%) [p=0.67] after aortoatrial cannulation. When comparing postoperative complications between the femoral cannulation and aortoatrial cannulation groups, the rates of atrial fibrillation [10/72 (13.9%) versus 46/274 (16.8%), p=0.55], renal failure [2/72 (2.78%) versus 11/274 (4.01%), p=0.62], prolonged ventilation time [4/72 (5.56%) versus 27/274 (9.85%), p=0.26] and re-operation for bleeding [3/72 (4.17%) versus 13/274 (4.74%), p=0.84] showed no significant difference. Selective femoral cannulation provides a safe alternative to aortoatrial cannulation for cardiopulmonary bypass and is especially important when performing minimally invasive cardiac surgery. When comparing aortoatrial and femoral cannulation, we found no significant difference in the postoperative complication rates and overall mortality.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Siavash
authors.initials: S
authors.lastname: Saadat
authors.affiliation: Monmouth Medical Center, Long Branch, NJ, USA mmschultheis@gmail.com.
authors.forename: Molly
authors.initials: M
authors.lastname: Schultheis
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Azzolini
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Romero
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Dombrovskiy
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Odroniec
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Scholz
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lemaire
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: George
authors.initials: G
authors.lastname: Batsides
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D062666:Vascular Access Devices
keywords: cardiopulmonary bypass; femoral cannulation; minimally invasive cardiac surgery