Central Aortic Cannulation in Minimally Invasive Cardiac Surgery via Right Thoracotomy: A Single-Center Retrospective Comparison

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 ± 0.10 vs. 1.59 ± 0.09 m, p < 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.