Background: Minimally invasive cardiac surgery (MICS) has progressively gained interest but, generally, requires peripheral routes of arterial and venous cannulation. Our objective is to rewiew a single institution experience based over many cases of Port-Access technique (PAT)
Methods: From March 1997 to June 2005 we performed 1734 MICS cases, of these 921 were done through a “J” ministernotmy, 813 cases were operated by means of PAT. At the beginnig of PAT experience we used a standard femoral arterial and venous cannulation; since 1999 we started using a direct transthoracic aortic cannulation (Endodirect™ ED). Our cumulative experience is 411 (50.5%) cases of ED (group A) and 402 (49.5%) of femoral artery cannulation (group B).
Ages and main cardiac pathologies as valve disease, septal defects, cardiac tumors, left ventricular aneurysm and coronary atherosclerotic stenosis were homogeneously distributed among these two groups.
Results: Surgical complications were in group A: posterior aortic wall perforation 1 cases, purse string rupture requiring side-biting clamping and repair 1 case, late bleeding from purse-string requiring surgical revision in 2 cases (total : 4/411 cases, 1%); in group B: aortic dissection in 4 pts, double femoral artery cannulation in 10 pts, conversion to endodirect 6 pts, femoral artery thrombosis- dissection 4 pts, wound dehiscence 11 pts, lymphatic leakage 12 pts (total 47/402, 12%).
Other differences between the two groups are reported in table 1.
Mortality procedure-related was seen only in group B (3pts) because of intraoperative aortic dissection.
Conclusions: In our experience ED technique is preferable and seems to appear safer than standard femoral cannulation but some peculiar surgical skills are mandatory in order to achieve a good level of safety .