Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery

Kastengren, Mikael; Svenarud, Peter; Källner, Göran; Settergren, Magnus; Franco‐Cereceda, Anders; Dalén, Magnus

doi:10.1016/j.athoracsur.2019.10.038

Cited by 16 publications

(17 citation statements)

References 13 publications

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“…Further potential advantages of the herein used closure device are absence of suture material and the remaining extravascular stainless steel lock indicating the exact position of vessel entry for possible re-interventions in case of later vessel complications. An earlier study suggested a higher rate of VARC-2 adjudicated vascular complications with the MANTA device compared to surgical cutdown ( 21 ). However, in this series no postoperative vessel complications in terms of bleeding, wound healing disorders/seroma formation or pseudoaneurysms were seen during 30-days follow-up, which was also seen in a previous study ( 22 ) and which further corroborates the assumption that the MANTA™ device has the potential to simplify MIS valve surgery and to reduce intra- and postoperative vessel complications.…”

Section: Discussionmentioning

confidence: 99%

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

Schaefer¹,

Sarwari²,

Reichenspurner³

et al. 2021

Front. Cardiovasc. Med.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Schaefer¹,

Sarwari²,

Reichenspurner³

et al. 2021

Front. Cardiovasc. Med.

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“…Generally, to prevent clotting in the ECMO circuit when reducing blood flow during weaning, additional heparin was administered to maintain activated clotting time > 400 s. The MANTA arterial closure procedure is illustrated in Figure 1. The use of the device has been previously described 3,11 . The device is composed of a delivery handle containing the closure unit, which consists of an absorbable collagen pad and an absorbable polymer toggle that are connected by a suture.…”

Section: Vascular Closure Techniquementioning

confidence: 99%

“…Access is today usually and preferably achieved percutaneously using the Seldinger technique, with aid of ultrasound guidance and micropuncture needles, but can also be performed with surgical cutdown and arterial puncture under direct vision in less urgent situations 1 . Traditionally, VA ECMO decannulation of cannulas placed percutaneously has been performed with surgical cutdown and purse‐string closure, however, cutdown in the groin is associated with a substantial risk for groin seroma/lymphatic leakage, infection, and impaired wound healing 2,3 . The large size of arterial ECMO cannulas (usually 17–21 Fr in adults) creates challenges for percutaneous arterial access management.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

Dalén

Settergren

Kastengren

et al. 2022

Cathet Cardio Intervent

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Background: There is limited experience of using the MANTA plug-based vascular closure device for percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation. Objectives: To study femoral artery complications and need for subsequent vascular interventions after percutaneous decannulation of venoarterial extracorporeal membrane oxygenation (VA ECMO) using the MANTA plug-based vascular closure device. Methods: We studied 34 consecutive patients who underwent percutaneous decannulation of VA ECMO using the MANTA device. Primary outcomes were conversion to surgical cutdown of the groin at decannulation (immediate) or later. Secondary outcomes were type of vascular complication necessitating conversion to surgical cutdown of the groin. Results: Six (17.7%) patients had to undergo immediate (n = 3) or late (n = 3) conversion to surgical cutdown of the groin. Of these, three were owing to occlusion of the common femoral artery resulting in insufficient distal perfusion and three owing to bleeding or pseudoaneurysm. The mechanism of failure was complete intravascular deployment of the MANTA device in three patients, incomplete MANTA sealing of the arteriotomy in one patient, MANTA-unrelated thrombotic occlusion in one patient, and unknown in one patient. Surgical cut-down was typically performed with concomitant catheter thrombectomy with or without patch reconstruction of the artery. Conclusion: Percutaneous decannulation of VA ECMO using the MANTA VCD was feasible but a substantial number of patients needed to be converted to unplanned surgical repair, owing to either closure site-located stenosis/occlusion or bleeding. If suboptimal MANTA positioning is suspected, a low threshold for conversion to surgical cutdown of the groin is recommended.

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“…The use of VCDs has been associated with an increased rate of vascular complications counterbalancing fewer wound infections and seromas. 7,14 The possible vascular complications during placement of VCDs and the cannulas can be prevented with the routine use of US and TEE. The routine utilization of US during placement of the Proglide sutures is crucial for correct orientation and placement that could otherwise result in femoral artery stenosis.…”

Section: The Total Percutaneous Approach Has Been Beneficial In Interventionsmentioning

confidence: 99%

Percutaneous cannulation for cardiopulmonary bypass in robotic mitral valve surgery with zero groin complications

Baştopçu

Şenay

Güllü

et al. 2021

Journal of Cardiac Surgery

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Introduction: Robotic valve surgery utilizes the femoral vessels to set up cardiopulmonary bypass (CPB) which translates to groin wound and lower extremity vascular complications. A less invasive technique is a totally percutaneous bypass using vascular closure devices (VCDs) with concerns for lower limb ischemia and arterial stenosis. Since April 2018, we have adopted the standard use of total percutaneous CPB in our robotic mitral cases. We report our institutional results with this technique.Methods: All consecutive patients who underwent robotic mitral valve surgery between April 2018 and December 2020 in our institution were included in our study.Hospital database data on demographics, operative variables, and surgical outcomes were recorded and analyzed.Results: Robotic mitral valve surgeries were performed on 32 consecutive patients (mean age 57.2 ± 14.8) between April 2018 and December 2020. None of our patients developed an infection at any site. Seroma, hematoma, or pseudoaneurysm were not observed at puncture sites. Surgical repair of the femoral vessels or an additional VCD was not necessary for any of our patients. Patients were followed up for a mean duration of 23.5 months. Our patients did not present with a late wound infection, a seroma, or a pseudoaneurysm, nor had complaints of limb ischemia or claudication. Conclusion:Total percutaneous bypass is the least invasive method of establishing extracorporeal circulation for cardiac surgery and can be performed with excellent results. The benefits of robotic surgery can be expanded with better results in groin cannulation by the adoption of total percutaneous CPB.

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Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery

Cited by 16 publications

References 13 publications

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

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

Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

Percutaneous cannulation for cardiopulmonary bypass in robotic mitral valve surgery with zero groin complications

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