Magnus Dalén

OBJECTIVES Large series of percutaneous femoral access for extracorporeal circulation in minimally invasive cardiac surgery (MICS) are scarcely reported. METHODS This is a single-centre study describing the use of percutaneous femoral access in patients undergoing MICS via minithoracotomy. Femoral artery closure was performed with a plug-based closure device. To reduce the risk for vascular complications, intraoperative ultrasound assessment of correct deployment of the arterial closure device was done during the later period of the study. RESULTS During a 5-year period, 650 patients underwent percutaneous femoral cannulation and decannulation with device closure of the femoral artery puncture. Two hundred and seven patients (31.8%) were operated in the early phase of the experience (August 2017–August 2019), without the use of intraoperative ultrasound assessment of closure device deployment. During the later period of our experience (August 2019–September 2022), 443 patients (68.2%) were operated, of whom all underwent intraoperative ultrasound assessment of closure device deployment. Of the patients operated without intraoperative ultrasound assessment, 6 patients (2.9%) experienced vascular complications compared with none of the patients in whom intraoperative ultrasound-assessment was used (P < 0.001). In total, 15 patients (2.3%) underwent conversion to surgical cutdown owing to incomplete haemostasis or femoral artery stenosis/occlusion and the mechanism was intravascular deployment of the closure device in all 15 cases. CONCLUSIONS Percutaneous femoral access in MICS is safe and the need for surgical cutdown was infrequent. The risk for vascular complications is minimized with the use of intraoperative ultrasound assessment of the correct positioning of the vascular closure device. CLINICAL TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov; Unique identifier: NCT05462769.