title: Elevated Stroke Risk Associated With Femoral Artery Cannulation During Mitral Valve Surgery.
abstract: Minimally invasive mitral valve (MV) surgery, often requiring femoral artery (FA) cannulation, is increasingly being adopted. There is concern about increased stroke rates associated with minimally invasive MV surgery. This study aims to examine whether FA cannulation is independently associated with increased stroke rates in minimally invasive MV procedures. MV procedures from January 2004 to June 2012 were reviewed using our institutional Society of Thoracic Surgeons database. We included 384 patients after the exclusion of patients with emergency procedures, with infective endocarditis, who underwent other concomitant procedures, who were older than 60 years, and with nonstandard aortic clamping (endoballoon or no clamp). Patients were divided into 2 groups: those who underwent aortic cannulation (n = 327) and those who underwent femoral cannulation (n = 57). Risk adjustments through multivariable regression were used to identify independent predictors for various outcomes. Adjustments were made for cardiopulmonary bypass and aortic clamp times. Preoperatively, the femoral cannulation group had less baseline cerebrovascular disease (P = 0.032), heart failure (P = 0.028), and atrial fibrillation (P = 0.012). Other baseline characteristics were similar. The aortic cannulation group had shorter cardiopulmonary bypass (P < 0.001) and clamp times (P < 0.001). There were more repairs done in the FA cannulation group as opposed to replacements. Risk-adjusted outcomes showed a higher incidence of permanent stroke in the femoral cannulation group (P = 0.032). Other outcomes were not significantly different. In conclusion, FA cannulation may be associated with increased stroke rates in isolated MV surgery. Antegrade arterial cannulation (direct aortic or axillary cannulation) may be preferable in minimally invasive MV procedures. Randomized trial data are needed.
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston, TX.
authors.forename: Kareem
authors.initials: K
authors.lastname: Bedeir
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Reardon
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston, TX.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Ramchandani
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston, TX.
authors.forename: Karanbir
authors.initials: K
authors.lastname: Singh
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston, TX.
authors.forename: Basel
authors.initials: B
authors.lastname: Ramlawi
mesh_terms: D000328:Adult; D001011:Aorta; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome
keywords: cannulation; cardiopulmonary bypass; minimally invasive cardiac surgery; mitral repair, stroke