{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:10:32Z","timestamp":1789053032809,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Femoral cannulation is essential for minimally invasive mitral valve surgery (MIMVS). Our center transitioned from open femoral cut-down to ultrasound-guided percutaneous cannulation supported by smart venous cannulas, ThruPort arterial access, and the MANTA closure device. This study evaluates how this transition affects procedural efficiency, vascular safety, and postoperative outcomes. Methods: We retrospectively analyzed 575 consecutive MIMVS patients (2014\u20132025). Patients treated before 2021 formed the cut-down group, while those from 2021 onward underwent percutaneous cannulation. The outcomes included operative times, groin and lymphatic complications, MANTA performance, and 30-day mortality. Propensity score matching (PSM) was performed to adjust for baseline differences. Results: Of 575 patients, 393 (68.3%) underwent cut-down and 182 (31.7%) percutaneous access. Percutaneous access was associated with shorter cardiopulmonary bypass times (115 vs. 128 min, p &lt; 0.0001), total operative times (210 vs. 242 min, p &lt; 0.0001), ICU stays (2 vs. 3 days, p = 0.0267), and hospital stays (8 vs. 11 days, p &lt; 0.0001). Lymph fistula occurred in 4.3% of cut-down cases and in 0% after the adoption of percutaneous access (p = 0.0004). Overall groin complication rates were comparable (2.8% vs. 4.9%, p = 0.51). MANTA closure had a 2.2% device-related complication rate (1.1% bleeding; 1.1% ischemia) with no documented long-term sequelae. Regarding 30-day mortality, this was 4.6% in the cut-down group and 1.6% in the percutaneous group (p = 0.096). In PSM (72 matched pairs), percutaneous access retained significantly shorter operative, bypass, and ICU times, with identical groin complication rates. Conclusions: Ultrasound-guided percutaneous femoral cannulation was associated with improved procedural efficiency and elimination of lymphatic morbidity, without increasing vascular risk or mortality. It represented a safe and effective standard strategy for contemporary MIMVS.<\/jats:p>","DOI":"10.3390\/medsci14020182","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T01:12:33Z","timestamp":1775437953000},"page":"182","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evolution of Femoral Cannulation Techniques in Minimally Invasive Mitral Valve Surgery: A 10-Year Experience"],"prefix":"10.3390","volume":"14","author":[{"given":"Jonah","family":"Schwarz","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parwis","family":"Massoudy","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9044-8866","authenticated-orcid":false,"given":"Marius Mihai","family":"Harpa","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-3427","authenticated-orcid":false,"given":"Markus","family":"Czesla","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Mogilansky","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Klinikum Passau, 94032 Passau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara","family":"Br\u00eenzaniuc","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9956-2312","authenticated-orcid":false,"given":"Emanuel-David","family":"Anitei","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7340-7472","authenticated-orcid":false,"given":"Robert","family":"Balan","sequence":"additional","affiliation":[{"name":"Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","first-page":"179569","article-title":"Minimally invasive mitral valve surgery: A systematic review","volume":"2013","author":"Rao","year":"2013","journal-title":"Minim. Invasive Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1093\/ejcts\/ezs195","article-title":"Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy","volume":"42","author":"Vollroth","year":"2012","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","first-page":"744","article-title":"Minimally invasive mitral valve surgery: \u201cThe Leipzig experience\u201d","volume":"2","author":"Davierwala","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Opris, D.R., Harpa, M.M., Anitei, D.E., Calburean, P., and Rudzik, R. (2025). Mitral Valve Prolapse and Sudden Cardiac Death\u2014A Puzzle with Missing Pieces: Review of the Literature and Case Report. Med. Sci., 13.","DOI":"10.3390\/medsci13030185"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/00000658-199710000-00003","article-title":"Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair","volume":"226","author":"Cohn","year":"1997","journal-title":"Ann. Surg."},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.jacc.2010.03.053","article-title":"Minimally-invasive valve surgery","volume":"56","author":"Schmitto","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","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. Cardio-Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1161\/CIRCULATIONAHA.112.001402","article-title":"Learning minimally invasive mitral valve surgery: A cumulative sum sequential probability analysis of 3895 operations from a single high-volume center","volume":"128","author":"Holzhey","year":"2013","journal-title":"Circulation"},{"key":"ref_10","first-page":"751","article-title":"Rate of repair in minimally invasive mitral valve surgery","volume":"2","author":"Perier","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_11","first-page":"853","article-title":"Conversion rate and contraindications for minimally invasive mitral valve surgery","volume":"2","author":"Vollroth","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_12","first-page":"422","article-title":"Minimally invasive mitral valve repair through right minithoracotomy in the setting of degenerative mitral regurgitation: Early outcomes and long-term follow-up","volume":"4","author":"Miceli","year":"2015","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.jcin.2016.12.277","article-title":"Percutaneous Plug-Based Arteriotomy Closure Device for Large-Bore Access: A Multicenter Prospective Study","volume":"10","author":"Latib","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"896","DOI":"10.4244\/EIJV12I7A147","article-title":"MANTA, a novel plug-based vascular closure device for large bore arteriotomies: Technical report","volume":"12","author":"Daemen","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"117","DOI":"10.23736\/S0021-9509.19.11087-7","article-title":"Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: Surgical versus percutaneous approach","volume":"61","author":"Walas","year":"2020","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.athoracsur.2019.10.038","article-title":"Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery","volume":"110","author":"Kastengren","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"106969","DOI":"10.1016\/j.dib.2021.106969","article-title":"Data on plug-based large-bore arteriotomy vascular closure device related access complications","volume":"36","author":"Nuis","year":"2021","journal-title":"Data Brief"},{"key":"ref_18","first-page":"1270","article-title":"Dedicated plug based closure for large bore access\u2014The MARVEL prospective registry","volume":"97","author":"Kroon","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijcard.2022.04.033","article-title":"Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations","volume":"359","author":"Kastengren","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"ezaf219","DOI":"10.1093\/ejcts\/ezaf219","article-title":"Percutaneous Cannulation for Minimally Invasive Heart Valve Surgery: Results from a Multicenter Registry","volume":"67","author":"Pausch","year":"2025","journal-title":"Eur. J. Cardio-Thorac. Surg. Off."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1177\/15569845241241534","article-title":"Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis","volume":"19","author":"Kirov","year":"2024","journal-title":"Innovations"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/icvts\/ivx140","article-title":"Percutaneous cannulation for cardiopulmonary bypass in minimally invasive surgery is associated with reduced groin complications","volume":"25","author":"Moschovas","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1055\/s-0042-1745812","article-title":"Percutaneous Cannulation of Femoral Vessels in Minimally Invasive Cardiac Surgery","volume":"71","author":"Sugimura","year":"2023","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"ezad020","DOI":"10.1093\/ejcts\/ezad020","article-title":"Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery","volume":"63","author":"Ma","year":"2023","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2514743","DOI":"10.1080\/14017431.2025.2514743","article-title":"Minimally invasive mitral valve surgery in a non-high volume center","volume":"59","author":"Granfeldt","year":"2025","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sellin, C., D\u00f6rge, H., Massoudy, P., Liebold, A., and Balan, R. (2024). Endo-Aortic Clamping with the IntraClude\u00ae Device in Minimally Invasive Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT). J. Clin. Med., 13.","DOI":"10.3390\/jcm13195891"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ghiragosian, C., Harpa, M., Stoica, A., S\u00e2nziana, F.O., B\u0103l\u0103u, R., Hussein, H.A., Elena, G.S., Neagoe, R.M., and Suciu, H. (2022). Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9060178"},{"key":"ref_28","first-page":"739","article-title":"Total percutaneous femoral vessels cannulation for minimally invasive mitral valve surgery","volume":"2","author":"Pozzi","year":"2013","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.xjtc.2022.08.021","article-title":"Percutaneous versus open surgical cannulation for minimal invasive cardiac surgery; immediate postprocedural outcome analysis","volume":"16","author":"Saeed","year":"2022","journal-title":"JTCVS Tech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1007\/s00059-009-3252-3","article-title":"Vascular access site complications after percutaneous transfemoral aortic valve implantation","volume":"34","author":"Kahlert","year":"2009","journal-title":"Herz"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Schaefer, A., Sarwari, H., Reichenspurner, H., and Conradi, L. (2021). A Novel Plug-Based Vascular Closure Device for Percutaneous Femoral Artery Closure in Patients Undergoing Minimally-Invasive Valve Surgery. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.682321"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Harpa, M.M., Anitei, E.D., Ghiragosian, C., Calburean, P., Opris, D.R., Banceu, M.C., Arbanasi, E.M., Suciu, H., and Al Hussein, H. (2025). Endoscopic Mitral Surgery in Noonan Syndrome-Case Report and Considerations. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020583"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Harpa, M.M., Oltean, S.F., Al Hussein, H., Anitei, D.E., Puscas, I.A., B\u0103nceu, C.M., Veres, M., Opri\u0219, D.R., Balau, R.A., and Suciu, H. (2024). Successful Treatment of Unilateral Pulmonary Edema as Minimally Invasive Mitral Valve Surgery Complication-Case Presentation. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247654"},{"key":"ref_34","unstructured":"Jarral, O.A., Pupovac, S., Mason, I., Tseng, J.-C., Chau, M., Kliger, C., Patel, N., Scheinerman, S.J., Hartman, A., and Brinster, D.R. (2025, November 05). Percutaneous Femoral Venous Cannulation\u2014How to Do It. Available online: https:\/\/www.ctsnet.org\/article\/percutaneous-femoral-venous-cannulation%E2%80%94how-do-it."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/182\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T01:31:14Z","timestamp":1775439074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020182"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020182","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}