{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:49:51Z","timestamp":1785761391353,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Femoral cannulation is the cornerstone of endoscopic minimally invasive heart valve surgery (MICS). We compared three femoral access strategies\u2014surgical cut-down, suture-based percutaneous closure (ProGlide\u00ae) and plug-based percutaneous closure (MANTA\u00ae)\u2014for access-site outcomes, operative times and 30-day morbidity. Methods: This is a retrospective single-centre analysis of 445 consecutive patients undergoing endoscopic MICS (February 2021\u2013May 2025). Access strategy (cut-down n = 119; ProGlide n = 219; MANTA n = 107) was selected by preoperative CT angiography and the surgeon\u2019s discretion, with hostile anatomy triaged to cut-down. Baseline characteristics, intraoperative timing, primary haemostasis, conversion and 30-day outcomes were compared; a multivariable model within the percutaneous cohort adjusted for arterial cannula size and baseline covariates was used. Results: The mean age was 61.6 \u00b1 11.3 years; 60.8% were male. EuroSCORE II was comparable between the percutaneous and cut-down groups (1.89 \u00b1 2.55 vs. 2.03 \u00b1 2.41; p = 0.594). Primary haemostasis was higher with MANTA than ProGlide (96.2% vs. 83.1%; p = 0.001; adjusted OR 4.79). Conversion to cut-down was similar (3.7% vs. 3.6%; p = 1.000). Intervention-requiring groin complications were fewer with percutaneous access (3.7% vs. 7.5%; p = 0.232). Cross-clamp, bypass and total operative times were shortest with MANTA (all p &lt; 0.001). In-hospital mortality was 2.1% vs. 1.6% (p = 1.000). Conclusions: In appropriately selected patients, percutaneous femoral cannulation in MICS is safe and is associated with fewer groin complications and shorter operative times than cut-down. Within the percutaneous arm, MANTA was associated with a higher rate of primary haemostasis in our institutional experience. Cut-down remains indispensable for hostile femoral anatomy.<\/jats:p>","DOI":"10.3390\/jcm15155999","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"5999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Versus Surgical Femoral Cannulation in Endoscopic Minimally Invasive Heart Valve Surgery: A Single-Centre Retrospective Comparison of Cut-Down, ProGlide and MANTA Closure Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-926X","authenticated-orcid":false,"given":"Ahmed","family":"Ghazy","sequence":"first","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Albitar","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0259-0844","authenticated-orcid":false,"given":"Edoardo","family":"Zancanaro","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7172-2658","authenticated-orcid":false,"given":"Daniel-Sebastian","family":"Dohle","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2098-0088","authenticated-orcid":false,"given":"Katja","family":"Buschmann","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Treede","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"ESC\/EACTS Scientific Document Group. 2025 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur. 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