Comparison of direct aortic and femoral cannulation for port-access cardiac operations

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 fight 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.