A Novel Plug-Based Vascular Closure Device for Percutaneous Femoral Artery Closure in Patients Undergoing Minimally-Invasive Valve Surgery

Objectives: Surgical exposure of groin vessels to establish cardiopulmonary bypass (CPB) for minimally-invasive valve surgery (MIS) is standard of care but may result in postoperative wound healing disorders or seroma formation. Therefore, adaption of transcatheter techniques for fully percutaneous insertion of CPB cannulae may improve clinical results. We herein analyze a single center experience with a novel plug-based vascular closure device for MIS.Methods: Between 03/2020 and 02/2021 MIS using the MANTA™ (Teleflex Medical Inc., Wayne, PA, USA) vascular closure device was performed in 28 consecutive patients (58.8 ± 10.6 years, 60.3% male, logEuroSCORE II 1.1 ± 0.8%) receiving mitral and/or tricuspid valve repair/replacement. Concomitant procedures were left atrial appendage occlusion and cryoablation for atrial fibrillation in 21.4% (6/28) and 10.7% (3/28) of patients, respectively. Data were retrospectively analyzed in accordance with standardized M-VARC definitions. MANTA™ device success and early safety was defined as absence of any access site or access related vascular injury and major and life-threatening bleeding complications.Results: MANTA™ device success with immediate hemostasis and early safety were 96.4% (27/28). In one case, device failure necessitated surgical cut down without further complications. Mean aortic cross clamp time and cardiopulmonary bypass were 96.5 ± 24.2 min and 150.2 ± 33.6 min. Stroke, renal failure or myocardial infarction were not observed. Intensive care unit and total hospital stay were 1.7 ± 0.8 days and 10.1 ± 5.7 days. Overall 30-day mortality was 0%. Post-procedure echocardiography presented one case of residual moderate tricuspid regurgitation and competent valves in all other cases.Conclusions: The MANTA™ device is safe and effective in MIS. Its ease of use and effectiveness to achieve immediate hemostasis have further simplified MIS.

Download Full-text

First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1718773 ◽

2020 ◽

Author(s):

Ali El-Sayed Ahmad ◽

Saad Salamate ◽

Mohamed Amer ◽

Sami Sirat ◽

Nadejda Monsefi ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Femoral Artery ◽

Academic Research ◽

Vascular Complications ◽

Valve Surgery ◽

Closure Device ◽

Vascular Closure Device ◽

Surgical Closure ◽

Minimally Invasive Valve Surgery

Abstract Background To more minimize the minimally invasive valve surgeries, percutaneous vascular access and closure has been used for the establishment of extracorporeal circulation. This study investigates early clinical outcomes of patients who received MANTA for femoral artery closure as first experiences in minimally invasive valve surgery. Methods Between January 2019 and July 2019, 103 consecutive patients (mean age: 58 ± 11 years) underwent video-assisted minimally invasive valve surgery through right anterior minithoracotomy at two cardiac surgery referral centers in Germany. Percutaneous cannulation for cardiopulmonary bypass and femoral artery closure with MANTA were performed in all patients: 18-F and 14-F MANTA were used in 88 (85.4%) and 15 (14.6%) patient, respectively. Mitral, aortic, tricuspid, and double valve surgeries were performed in 51 (49.5%), 39 (37.9%), 7 (6.8%), and 6 (5.8%), patients, respectively. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time and cross-clamping time were 69 ± 23 and 38 ± 14 minutes, respectively. Except for two patients with late pseudoaneurysm on 15th and 23th postoperative day, neither major nor minor vascular complications nor vascular closure device failure according to the Valve Academic Research Consortium-2 definition criteria was observed. Additionally, no wound healing disorders or conversion to surgical closure was observed. Conclusions MANTA as percutaneous femoral artery closure after decannulation of cardiopulmonary bypass is a safe, feasible, and effective approach and yields excellent early outcomes. Larger size studies are needed to evaluate more the efficacy and safety of MANTA.

Download Full-text

First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery

10.1055/s-0040-1705487 ◽

2020 ◽

Author(s):

A. El-Sayed Ahmad ◽

S. Salamate ◽

M. Amer ◽

S. Sirat ◽

Ö. Akhavuz ◽

...

Keyword(s):

Minimally Invasive ◽

Valve Surgery ◽

Closure Device ◽

Vascular Closure Device ◽

Minimally Invasive Valve Surgery

Download Full-text

Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.10.038 ◽

2020 ◽

Vol 110 (1) ◽

pp. 85-91 ◽

Cited By ~ 2

Author(s):

Mikael Kastengren ◽

Peter Svenarud ◽

Göran Källner ◽

Magnus Settergren ◽

Anders Franco-Cereceda ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Closure Device ◽

Vascular Closure Device

Download Full-text

Minimally invasive valve surgery using high resolution (3D) scope

Operative Techniques in Thoracic and Cardiovascular Surgery ◽

10.1053/j.optechstcvs.2021.06.016 ◽

2021 ◽

Author(s):

Toshiaki Ito ◽

Soh Hosoba ◽

Mamoru Orii ◽

Riku Kato

Keyword(s):

High Resolution ◽

Minimally Invasive ◽

Valve Surgery ◽

Minimally Invasive Valve Surgery

Download Full-text

Robotic Mitral Valve Surgery and Unilateral Pulmonary Edema

Cardiothoracic Critical Care ◽

10.1093/med/9780190082482.003.0017 ◽

2020 ◽

pp. 171-178

Author(s):

Cindy Cheung ◽

Christopher W. Tam

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Pulmonary Edema ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Blood Product Transfusion ◽

Unilateral Pulmonary Edema ◽

Less Invasive Approach ◽

The Difference

This chapter describes robotic or minimally invasive mitral valve surgery, which was pioneered in 1998 to be the less invasive approach to sternotomy-based mitral valve operations. Patients undergoing robotic valve surgery carry a similar risk of complications that may occur with traditional median sternotomy surgery, but minimally invasive valve surgery has its own inherent complications associated with cardiac access, perfusion, and ventilation methods used in robotic surgeries. Unilateral pulmonary edema (UPE) is an uncommon but potentially life-threatening complication of robotic mitral valve surgery. The incidence of unilateral lung injury, which commonly manifests as UPE, has been reported to be quite variable. The variation in incidence could be related to the difference in patient populations, diagnostic criteria, as well as management. Moreover, the pathophysiology of UPE associated with robotic mitral valve repair remains unclear. The current literature suggests that UPE can be prevented by shorter cardiopulmonary bypass times, avoiding barotrauma, limiting blood product transfusion, and minimizing lung isolation times. Lung preventive ventilation, such as low-level positive pressure and frequent alveolar recruitment, while on cardiopulmonary bypass may be beneficial. Meanwhile, treatment for UPE is dependent on the severity of symptoms.

Download Full-text

Safety of Single-Dose Histidine-Tryptophan-Ketoglutarate Cardioplegia during Minimally Invasive Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451400900604 ◽

2014 ◽

Vol 9 (6) ◽

pp. 416-420 ◽

Cited By ~ 3

Author(s):

Carlo Savini ◽

Giacomo Murana ◽

Marco Di Eusanio ◽

Sofia Martin Suarez ◽

Giuliano Jafrancesco ◽

...

Keyword(s):

Single Dose ◽

Mitral Valve ◽

Minimally Invasive ◽

Myocardial Protection ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Aortic Cross Clamp Time ◽

Htk Solution ◽

Cardioplegic Solutions ◽

Creatine Kinase Isoenzyme Mb

Objective Minimally invasive mitral valve surgery may require a prolonged period of myocardial ischemia. Cardioplegic solutions that necessitate a single dose for adequate myocardial protection are evoked to simplify surgery and result to be appealing in this setting. The aim of this study was to assess early outcomes after minimally invasive mitral valve surgery using one single dose of histidine-tryptophanketoglutarate solution (HTK; Custodiol) for myocardial protection. Methods Between February 2003 and October 2012, a total of 49 consecutive patients underwent minimally invasive mitral valve surgery using a single dose of HTK solution for myocardial protection. The patients’ mean (SD) age was 57 (14) years; the preoperative ejection fraction was normal in all cases. The mean (SD) CPB time and aortic cross-clamp time were 148 (45) minutes and 97 (45) minutes, respectively. Results The heart spontaneously restarted after cross-clamp removal in 37 patients (75.5%). Five patients (10.2%) required prolonged inotropic drug support. Postoperatively, no significant increase in myocardial cytonecrosis enzymes was found [mean (SD) creatine kinase isoenzyme MB, 77.14 (53.67) μg/L at 3 hours, 71.2 (55.67) μg/L at 12 hours, and 42.53 (38.38) μg/L at 24 hours)], and no ischemic electrocardiogram modifications were observed before discharge. Conclusions During minimally invasive mitral valve surgery, HTK solution provided excellent myocardial protection even after prolonged periods of cardioplegic arrest. The avoidance of repetitive infusions may reduce the risk for coronary malperfusion due to dislodgement of the endoaortic clamp (if used) and increase the surgeon's comfort during the procedure.

Download Full-text