Minimally invasive mitral valve surgery (MIV-MVS) continues to evolve through refinements in surgical technique and perioperative management. This study evaluated the association between arterial cannulation strategy and perioperative adverse events.

Three arterial cannulations were used: central ascending aortic cannulation (AC), open femoral cannulation via groin cutdown (oFC), and percutaneous femoral cannulation (pFC) using pre-closure devices. Patients from 2 centres were assessed for the composite safety end-point of 30-day mortality or stroke, the composite efficacy end-point of all-cause death, stroke, or cannulation-related adverse events, and postoperative delirium. Cannulation-related adverse events included conversion to sternotomy or re-thoracotomy, vessel dissection or bleeding, and cannulation-site infection.

Between January 2013 and January 2020, 823 patients underwent MIV-MVS. Aortic cannulation was performed in 266 patients (32.3%), oFC in 396 (48.1%), and pFC in 161 (19.6%). The composite end-point of 30-day all-cause death or stroke occurred in 19 patients (2.3%) and was similar between AC and FC (odds ratio [OR] 1.16, 95% CI, 0.41-3.16). The extended composite efficacy end-point occurred less frequently with AC than with any FC (OR 0.46, 95% CI, 0.21-0.94), mainly due to fewer access-site complications. Aortic cannulation was also associated with lower odds of perioperative delirium (OR 0.51, 95% CI, 0.29-0.86). No significant difference was observed between oFC and pFC.

In patients undergoing MIV-MVS, 30-day death or stroke was similar across cannulation strategies. Aortic cannulation was associated with a lower rate of cannulation-related complications and less perioperative delirium than FC, largely reflecting fewer access-site complications. Further prospective external validation is warranted.