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• W2213824260 abstract "See related article on pages 97–103. In this issue of Seminars, Bedeir et al examine 57 minimally invasive mitral operations performed with retrograde femoral arterial cannulation between 2004 and 2012 at the Methodist DeBakey Heart and Vascular Center and compared them to 327 case-matched patients with central cannulation performed during the same 8-year period. Upon observing an elevated stroke rate in their femorally perfused patients, the authors elegantly and provocatively reactivate the once quelled debate on whether or not femoral arterial cannulation is to blame for complications in minimally invasive mitral valve surgery. The optimal cannulation strategy for minimally invasive mitral surgery has been a topic of controversy for nearly 20 years. Perhaps we might better define this debate by framing 3 separate eras in our evolution with mini right thoracotomy approaches to mitral repair and the use of retrograde femoral arterial perfusion. Era 1 was from 1996-2000 when the “heart port” technology was introduced simultaneously with a myriad of new exposure devices and instruments. Cannulae were 21-24 Fr and balloon aortic occlusion use was developed. Prescient and dedicated centers had good results but laudably identified a new series of femoral arterial complications. Era 2 arose from experience gained from 2001-2010 as wider adoption occurred with existing Era-1 perfusion technology but with limited reproducibility of results. This cannulation strategy was applied to a broad array of patient age and casetypes including redo operations. Unsatisfactory results with femoral cannulation and balloon occlusion, led several large centers to switch to central cannulation and cross-clamping with a reduction in stroke rate and retrograde dissection. Bedeir et al duly note these findings in their reference to a trends analysis of 2004-2008 data; however, this analysis of an earlier version of the Society of Thoracic Surgeons database used femoral cannulation merely as a surrogate for minimally invasive surgery, and when fibrillatory arrest was excluded from the analysis, the stroke rate was only 1.52%. Nevertheless, registry data combined with clinical experiences between 2001 and 2010, such as those experienced by Bedeir et al during the similar time frame, caused surgeons to justly pause before using femoral cannulation. Later in this similar era, it was determined that redo mitral operations performed with femoral cannulation" @default.
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• W2213824260 date "2015-01-01" @default.
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• W2213824260 title "Are We Going Backwards or Forwards in Minimally Invasive Mitral Valve Surgery? Three Eras of Perfusion Strategy" @default.
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• W2213824260 doi "https://doi.org/10.1053/j.semtcvs.2015.09.002" @default.
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