{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T13:40:39Z","timestamp":1774014039520,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Minimally invasive cardiac surgery via right thoracotomy commonly uses femoral arterial cannulation for cardiopulmonary bypass (CPB), which requires an additional groin incision and may be associated with access-related complications. Central aortic cannulation through the same thoracotomy allows antegrade perfusion without an extra incision. This study compared central aortic and femoral arterial cannulation strategies in minimally invasive cardiac surgery via right thoracotomy. Methods: This retrospective, single-center study included 139 consecutive patients undergoing minimally invasive right thoracotomy cardiac surgery with CPB between February 2021 and June 2023. Patients were grouped according to arterial cannulation strategy: central aortic cannulation (n = 93) and femoral arterial cannulation (n = 46). Demographic characteristics, operative variables, transfusion requirements, biochemical parameters, and early postoperative clinical outcomes were compared between the groups. Results: Baseline demographic characteristics differed between groups (age, height, body surface area, and sex distribution), and these differences should be considered potential confounders when interpreting outcome comparisons. Central cannulation was more frequently used in women (74.2% vs. 45.7%, p = 0.001). Patients in the femoral group were older (median 61.0 vs. 54.0 years, p = 0.004), taller (1.65 \u00b1 0.10 vs. 1.59 \u00b1 0.09 m, p &lt; 0.001), and had a slightly higher body surface area (p = 0.043). Cross-clamp and CPB durations were longer in the femoral group (cross-clamp: 90.0 vs. 70.5 min, p = 0.015; CPB: 137.0 vs. 114.0 min, p = 0.003). Lymphatic leakage occurred in three patients in the femoral group (6.5% vs. 0%, p = 0.009). No significant differences were observed between groups for mortality, intensive care unit stay, or neurological events. Conclusions: Central aortic cannulation via right thoracotomy is a feasible alternative to femoral arterial cannulation, enabling antegrade perfusion without a groin incision, reducing operative time, and potentially decreasing access-related complications such as lymphatic leakage, while yielding comparable early clinical outcomes. These findings should be interpreted cautiously given the retrospective design and baseline differences between groups.<\/jats:p>","DOI":"10.3390\/jcm15062383","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:49:58Z","timestamp":1774003798000},"page":"2383","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Central Aortic Cannulation in Minimally Invasive Cardiac Surgery via Right Thoracotomy: A Single-Center Retrospective Comparison"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9605-7543","authenticated-orcid":false,"given":"Tayfun","family":"\u00d6zdem","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, Ministry of Health, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5254-3339","authenticated-orcid":false,"given":"Tuna","family":"Demirk\u0131ran","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, Ministry of Health, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1449-7874","authenticated-orcid":false,"given":"Mesut","family":"Akyol","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Medical Faculty, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I\u015f\u0131l","family":"Ta\u015f\u00f6z \u00d6zda\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, Ministry of Health, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6682-9386","authenticated-orcid":false,"given":"Furkan Burak","family":"Akyol","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, Ministry of Health, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9793-8040","authenticated-orcid":false,"given":"Yi\u011fit","family":"Tokg\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veli Can","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-8565","authenticated-orcid":false,"given":"Emre","family":"Kubat","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, \u0130skenderun Geli\u015fim Hospital, 31200 Hatay, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6123-0457","authenticated-orcid":false,"given":"G\u00f6khan","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Kadan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Memorial Ankara Hospital, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kubilay","family":"Karabacak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, G\u00fclhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4790","DOI":"10.1111\/jocs.17124","article-title":"Robotic-assisted beating heart mitral valve surgery: Preliminary report","volume":"37","author":"Bolcal","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rubino, T.E., Jackson, A., Winter, M., Punu, K., Ashraf, S.F., Dufendach, K., Hess, N., Deitz, R., Waterford, S.D., and Kaczorowski, D. (2025). Small cuts, big questions: The impact of incision length in minimally invasive robotic cardiac surgery. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1575779"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1177\/15569845251396471","article-title":"Comparative Outcomes of Right Anterior Minithoracotomy and Ministernotomy for Aortic Valve Replacement: An Updated Meta-Analysis","volume":"20","author":"Santos","year":"2025","journal-title":"Innovations"},{"key":"ref_4","first-page":"e101766","article-title":"Single-Center Experience with Minimally Invasive Approaches from Sternotomy to Thoracoscopy: Assessing the Learning Curve and Benefits","volume":"18","author":"Elsayed","year":"2026","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1053\/j.jvca.2024.04.041","article-title":"Minimally Invasive Approach versus Sternotomy for Cardiac Surgery in Jehovah\u2019s Witness Patients","volume":"38","author":"Lee","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s00268-009-0260-7","article-title":"Eight-year experience with minimally invasive cardiothoracic surgery","volume":"34","author":"Iribarne","year":"2010","journal-title":"World J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1053\/j.semtcvs.2015.06.008","article-title":"Elevated stroke risk associated with femoral artery cannulation during mitral valve surgery","volume":"27","author":"Bedeir","year":"2015","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/imi.0b013e3182167feb","article-title":"Minimally invasive versus conventional open mitral valve surgery: A meta-analysis and systematic review","volume":"6","author":"Cheng","year":"2011","journal-title":"Innovations"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/j.athoracsur.2010.05.055","article-title":"Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons adult cardiac surgery database","volume":"90","author":"Gammie","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1016\/j.athoracsur.2016.09.098","article-title":"Complications associated with femoral cannulation during minimally invasive cardiac surgery","volume":"103","author":"Lamelas","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","first-page":"363","article-title":"Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: A single-institution experience with 1632 patients over 12 years","volume":"24","author":"Murzi","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/imi.0000000000000358","article-title":"Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy and Central Aortic Cannulation: A 13-Year Experience","volume":"12","author":"Bethencourt","year":"2017","journal-title":"Innovations"},{"key":"ref_13","first-page":"59","article-title":"Central versus femoral cannulation during minimally invasive aortic valve replacement","volume":"4","author":"Murzi","year":"2015","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1186\/s13019-024-02945-y","article-title":"Right thoracotomy with central cannulation for valve surgery: 10 years of experience","volume":"19","author":"Sharma","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1016\/j.hlc.2018.08.018","article-title":"Minimally Invasive Cardiac Surgery Without Peripheral Cannulation: A Single Centre Experience","volume":"28","author":"Kale","year":"2019","journal-title":"Heart Lung Circ."},{"key":"ref_16","first-page":"6247","article-title":"Minimally invasive cardiac surgery in low-resource settings: Right vertical infra-axillary mini-thoracotomy without peripheral cannulation\u2014The first 100 cases","volume":"27","author":"Sevuk","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1053\/j.semtcvs.2017.02.007","article-title":"Central Cannulation as a Viable Alternative to Peripheral Cannulation in Extracorporeal Membrane Oxygenation","volume":"29","author":"Ranney","year":"2017","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"420","DOI":"10.21470\/1678-9741-2019-0445","article-title":"Peripheral vs. Central Cannulation in Cardiac Reoperations: Technical Considerations and Outcomes","volume":"35","author":"Ata","year":"2020","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/15569845251333344","article-title":"State-of-the-Art Review: Advantages and Disadvantages of Femoral Versus Central Cannulation","volume":"20","author":"Werner","year":"2025","journal-title":"Innovations"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.1016\/j.jtcvs.2012.01.011","article-title":"Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair","volume":"143","author":"Grossi","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"875","DOI":"10.21470\/1678-9741-2021-0098","article-title":"Outcomes of aortic valve replacement via right anterior minithoracotomy and central cannulation versus conventional aortic valve replacement in obese patients","volume":"37","author":"Abud","year":"2022","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Petersen, J., Naito, S., Kloth, B., Pecha, S., Zipfel, S., Alassar, Y., Detter, C., Conradi, L., Reichenspurner, H., and Girdauskas, E. (2022). Antegrade axillary arterial perfusion in 3D endoscopic minimally-invasive mitral valve surgery. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.980074"},{"key":"ref_23","first-page":"57323","article-title":"Technique and patient selection criteria of right anterior mini-thoracotomy for minimal access aortic valve replacement","volume":"133","author":"Tavakoli","year":"2018","journal-title":"J. Vis. Exp."},{"key":"ref_24","first-page":"ivad101","article-title":"Endoscopic aortic valve surgery in isolated and concomitant procedures","volume":"36","author":"Zoni","year":"2023","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"788","DOI":"10.21470\/1678-9741-2021-0234","article-title":"A modified ascending aortic cannulation technique in minimally invasive totally thoracoscopic cardiac surgery","volume":"37","author":"Liao","year":"2022","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Liu, Z., Maimaitiaili, A., Ma, X., Dong, S., Wei, W., Wang, Q., Chen, Q., Liu, J., and Guo, Z. (2024). Initial experience and favorable outcomes on cannulation strategies and surgical platform construction in fully video-assisted thoracoscopic cardiac surgery. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1414333"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/s13019-021-01584-x","article-title":"Open Seldinger-guided peripheral femoro-femoral cannulation technique for totally endoscopic cardiac surgery","volume":"16","author":"Chen","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3293","DOI":"10.1053\/j.jvca.2025.08.027","article-title":"Prospective evaluation of thrombotic complications after internal jugular vein cannulation for external bypass","volume":"39","author":"Flinspach","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110492","DOI":"10.1016\/j.cclet.2024.110492","article-title":"Review of recent progress in vascular stents: From conventional to functional vascular stents","volume":"36","author":"Li","year":"2025","journal-title":"Chin. Chem. Lett."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.actbio.2025.10.034","article-title":"Gadolinium nanoparticle-enhanced, radiopaque, and resorbable inferior vena cava filters for improved in vivo applications","volume":"207","author":"Damasco","year":"2025","journal-title":"Acta Biomater."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"214052","DOI":"10.1016\/j.bioadv.2024.214052","article-title":"Bismuth-infused perivascular wrap facilitates delivery of mesenchymal stem cells and attenuation of neointimal hyperplasia in rat arteriovenous fistulas","volume":"166","author":"Barcena","year":"2025","journal-title":"Biomater. Adv."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s43057-020-00019-y","article-title":"Minimally invasive aortic valve replacement with central cannulation: A cost-benefit analysis in a developing country","volume":"28","author":"Sanad","year":"2020","journal-title":"Cardiothorac. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.ejcts.2008.07.057","article-title":"Minimally invasive mitral valve surgery: A systematic review and meta-analysis","volume":"34","author":"Modi","year":"2008","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"111159","DOI":"10.4330\/wjc.v17.i8.111159","article-title":"Comparative outcomes of robotic surgery vs conventional sternotomy for cardiac myxoma excision: A meta-analysis","volume":"17","author":"Khawar","year":"2025","journal-title":"World J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2383\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:05:11Z","timestamp":1774004711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062383"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062383","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}