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Meta-Analysis
. 2024 May-Jun;19(3):247-253.
doi: 10.1177/15569845241241534. Epub 2024 Apr 11.

Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis

Hristo Kirov  1 , Tulio Caldonazo  1 , Angelique Runkel  1 , Johannes Fischer  1 , Panagiotis Tasoudis  2 , Murat Mukharyamov  1 , Gianmarco Cancelli  3 , Michele Dell'Aquila  3 , Torsten Doenst  1
Affiliations
Meta-Analysis

Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis

Hristo Kirov et al. Innovations (Phila). 2024 May-Jun.

Abstract

Objective: Minimally invasive cardiac surgery (MICS) is increasing worldwide. In most cases, the surgical technique includes cannulation of the groin for the establishment of cardiopulmonary bypass, requiring a second surgical incision (SC) for exposure and cannulation of the femoral vessels. With the introduction of arterial closure devices, percutaneous cannulation (PC) of the groin has become a possible alternative. We performed a meta-analysis and systematic review to compare clinical endpoints between the patients who underwent PC and SC for MICS.

Methods: Three databases were assessed. The primary outcome was any access site complication. Secondary outcomes were perioperative mortality, any wound complication, any vascular complication, lymphatic complications, femoral/iliac stenosis, stroke, procedural duration, and hospital length of stay (LOS). A random effects model was performed.

Results: A total of 5 studies with 2,038 patients were included. When compared with PC, patients who underwent SC showed a higher incidence of any access site complication (odds ratio [OR] = 3.09, 95% confidence interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR = 10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR = 9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration (standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01). There was no significant difference between the 2 groups regarding perioperative mortality, any vascular complication, femoral/iliac stenosis, stroke, or hospital LOS.

Conclusions: The analysis suggests that surgical groin cannulation in MICS is associated with a higher incidence of any access site complication (especially wound complication and lymphatic fistula) and with a longer procedural time compared with PC. There was no difference in perioperative mortality.

Keywords: femoral cannulation; minimally invasive cardiac surgery; percutaneous cannulation.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Visual abstract
Visual abstract
Fig. 1.
Fig. 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Fig. 2.
Fig. 2.
Forest plot for any access site complication. CI, confidence interval; OR, odds ratio; PC, percutaneous cannulation; SC, surgical cannulation.
Fig. 3.
Fig. 3.
Forest plot for perioperative mortality. CI, confidence interval; OR, odds ratio; PC, percutaneous cannulation; SC, surgical cannulation.
Fig. 4.
Fig. 4.
Forest plot for any wound complication. CI, confidence interval; OR, odds ratio; PC, percutaneous cannulation; SC, surgical cannulation.
Fig. 5.
Fig. 5.
Forest plot for any vascular complication. CI, confidence interval; OR, odds ratio; PC, percutaneous cannulation; SC, surgical cannulation.
See this image and copyright information in PMC

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