Methods: Thirty consecutive patients undergoing complete or partial femoral cannulation during 2 year period were evaluated. Access was achieved through limited oblique inguinal incision. Cannulation was performed by transesphageal echocardiography-directed catheter-guided Seldinger-technique. Cannula transfer was avoided.
Results: pCPB was indicated for mini-aortic valve replacement, aortic dissection, redo operations and hemi-arch repair in 47% %, 30%, 20% and 3%, respectively. Mean age was 64 ± 3 years (female 37%; emergent 30%; EuroScore, overall 18 %, elective 12.3%, emergent 33.1%). The respective average BSA and BMI was 1.9 ± 0.4 m2 (range, 1.7-2.1 m2) and 28.4 ± 3.2 kg/m2 (range, 22-38 Kg/m2). Inguinal incision length averaged 3 ± 0.5 cm. Concomitant arterial and venous cannulation (complete pCPB), venous only and arterial only were performed in 47%, 43% and 10%, respectively. Overall access-failure rate was 3.2% (1/31); comparable between emergency and elective operations, p=0.522). Supplemental right atrial venous cannula (augmented venous return) was warranted in 2 patients (6.6%). Average time to retrieval of venous and arterial cannulas was 109 ± 10.5 min and 118 ± 8.4 min, respectively. Perioperative stroke or iatrogenic aortic dissection was not documented. Inguinal wound or femoral artery or vein re-explorations or were not recorded. During follow-up (median, 11 months, 1 to 24), vascular- related stenotic complications, need for antibiotic-treatment or lymphocele were not documented.
Conclusion: Irrespective of the underlying condition femoral access is highly feasible and its benefits outweigh the risks. Over-the-wire cannula insertion precludes the need for early arterial or venous cannula transfer.
Objective: Refinements in surgical equipment and techniques have led to increased use of peripheral cardiopulmonary bypass (pCPB). Access-failure rate, safe duration pending cannula removal and the incidence of early and late vascular or non-vascular complications following femoral approach remain undetermined.
