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

Q: What are the key findings of this study?

Percutaneous femoral cannulation resulted in a non-significant difference in intervention-requiring groin complications compared to surgical cut-down (3.7% vs 7.5%, p=0.232).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Endoscopic minimally invasive heart valve surgery (MICS) (n=445). Intervention: Percutaneous femoral cannulation vs. Surgical cut-down. Primary outcome: Intervention-requiring groin complications (p=0.232).

Q: What does this research mean for the field?

In appropriately selected patients undergoing endoscopic minimally invasive heart valve surgery, percutaneous femoral cannulation is safe and yields shorter operative times and fewer groin complications than surgical cut-down, with MANTA closure achieving higher primary haemostasis than ProGlide. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmed Ghazy; Mohamad Albitar; Edoardo Zancanaro; Daniel‐Sebastian Dohle; K. Buschmann; Hendrik Treede

doi:10.3390/jcm15155999

August 1, 2026Journal of Clinical MedicineOpen Access

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

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Key result

Percutaneous femoral cannulation shows no significant difference in groin complications compared to surgical cut-down.

P=0.232
n=445

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Why the study?

Femoral cannulation is essential in endoscopic minimally invasive heart valve surgery, but access-site outcomes, operative times, and 30-day morbidity needed comparison across surgical cut-down, suture-based, and plug-based percutaneous closure.

Does percutaneous femoral cannulation reduce intervention-requiring groin complications compared to surgical cut-down in patients undergoing endoscopic minimally invasive heart valve surgery?

Key Points

To compare access-site outcomes, operative durations, and 30-day morbidity among surgical cut-down, suture-based closure (ProGlide), and plug-based closure (MANTA) in endoscopic minimally invasive heart valve surgery.
Retrospective single-centre study of 445 consecutive patients undergoing endoscopic minimally invasive heart valve surgery between February 2021 and May 2025.
Access strategy was allocated based on preoperative computed tomography angiography and surgeon discretion into surgical cut-down (n = 119), ProGlide closure (n = 219), or MANTA closure (n = 107), with hostile vascular anatomy triaged to cut-down.
Multivariable regression within the percutaneous cohort adjusted for arterial cannula size and baseline covariates to evaluate predictors of primary haemostasis.
Primary haemostasis was achieved in 96.2% of MANTA patients versus 83.1% of ProGlide patients (p = 0.001; adjusted OR 4.79, 95% CI: 1.64–13.95; p = 0.004) and 100% of cut-down patients (p = 0.105 vs. MANTA).
Intervention-requiring groin complications occurred in 3.7% of percutaneous access patients compared to 7.5% in the cut-down group (p = 0.232), with cut-down conversion rates of 3.7% for MANTA and 3.6% for ProGlide (p = 1.000).
Cardiopulmonary bypass, aortic cross-clamp, and total operative times were significantly shortest with MANTA, intermediate with ProGlide, and longest with cut-down (all p < 0.001), while in-hospital mortality was 2.1% versus 1.6% (p = 1.000).

Study Design

Type

Cohort (n=445)

Multicenter

No

Structured PICO

Does percutaneous femoral cannulation reduce intervention-requiring groin complications compared to surgical cut-down in patients undergoing endoscopic minimally invasive heart valve surgery?

P

Population

445 adult patients undergoing endoscopic minimally invasive heart valve surgery with femoral cannulation, mean age 61.6 years, 39.2% female, followed for 30 days.

E

Exposure

Percutaneous femoral cannulation using suture-based (ProGlide, n=219) or plug-based (MANTA, n=107) closure devices.

C

Comparator

Surgical cut-down with primary vascular repair (n=119).

O

Outcome

Incidence of intervention-requiring groin complications (any access-related event mandating surgical or endovascular treatment) at 30 days.safety

Main Result

Absolute Event Rate: 3.7% vs 7.5%

p-value: p=0.232

Percutaneous femoral cannulation is a safe alternative to surgical cut-down in appropriately selected patients undergoing minimally invasive heart valve surgery, offering shorter operative times and potentially fewer local wound complications.

Limitations

Retrospective single-centre analysis
Non-randomized allocation with selection bias (hostile anatomy triaged to cut-down)
Lack of long-term follow-up imaging of the femoral access site
Differences in arterial cannula calibre among groups
Non-randomized allocation (surgeon discretion based on anatomy)
Lack of long-term follow-up imaging
Unmeasured confounders like arterial cannula calibre differences

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Implication

No significant difference in groin complications supports percutaneous access feasibility; leaves open randomized evaluation in endoscopic valve surgery.

Abstract

Background/Objectives: Femoral cannulation is the cornerstone of endoscopic minimally invasive heart valve surgery (MICS). We compared three femoral access strategies—surgical cut-down, suture-based percutaneous closure (ProGlide®) and plug-based percutaneous closure (MANTA®)—for 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–May 2025). Access strategy (cut-down n = 119; ProGlide n = 219; MANTA n = 107) was selected by preoperative CT angiography and the surgeon’s 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 ± 11.3 years; 60.8% were male. EuroSCORE II was comparable between the percutaneous and cut-down groups (1.89 ± 2.55 vs. 2.03 ± 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 < 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.

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Cite This Study

Ghazy et al. (2026) conducted a cohort in Endoscopic minimally invasive heart valve surgery (MICS) (n=445). Percutaneous femoral cannulation vs. Surgical cut-down was evaluated on Intervention-requiring groin complications (p=0.232). Percutaneous femoral cannulation resulted in a non-significant difference in intervention-requiring groin complications compared to surgical cut-down (3.7% vs 7.5%, p=0.232).

synapsesocial.com/papers/6aa7f228f6628622948dabde https://doi.org/10.3390/jcm15155999

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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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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