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

Background. Differences in outcome after direct aortic cannulation (AORT) i n the chest versus standard femoral arterial cannulation (FEM) have not bee n defined for minimally invasive cardiac operations utilizing the port-acce ss approach. Methods. A retrospective study was performed of 165 patients undergoing por t-access cardiac mitral valve operation (n = 126) or coronary artery bypass grafting (n = 39). In 113 patients, FEM was used, while in 52 patients, AO RT was accomplished through a port in the first intercostal space. Results. AORT eliminated endoaortic balloon clamp migration (0/36 [0%] vs 1 7/95 [18%]), and groin wound or femoral arterial complications (0/52 [0%] v s 11/113 [10%]) without changing procedure times (363 +/- 55 vs 355 +/- 70 minutes). Complications attributable to AORT were injury to the right inter nal mammary artery and aortic cannulation site bleeding in 1 patient each. Conclusions. Direct aortic cannulation is technically easy, allows use of a n endoaortic clamp, and avoids aorto-iliac arterial disease, the groin inci sion, and possible femoral arterial injury associated with femoral arterial cannulation. Direct arterial cannulation should expand the pool of patient s eligible for port-access operation, and may become the standard for port- access procedures. (C) 1999 by The Society of Thoracic Surgeons.