Femoral Cannulation Is Safe in the Context of Minimally Invasive Aortic Valve Surgery

All articles of this category (opens in new window) Background: Femoral cannulation for extracorporeal circulation (ECC) is widely accepted in minimally invasive mitral valve surgery. However, its role in minimally invasive aortic valve surgery remains a matter of ongoing debate. Methods: The study group comprised 2,000 patients undergoing minimally invasive cardiac surgery with femoral cannulation for ECC. Outcomes of 1,000 consecutive aortic valve procedures were compared with 1,000 consecutive mitral valve procedures. Endpoints were overall stroke rate (modified Rankin Scale ≥ 1 at discharge), postoperative transient ischemic attack (TIA), postoperative delirium, and major vascular access complications. Results: Baseline characteristics were comparable with respect to age (aortic: 67.9 ± 8.3 years vs. mitral: 66.6 ± 11.4 years; p = 0.145), sex (aortic: 63.6% male vs. mitral: 56.5%; p = 0.086), and EuroScore II (aortic: 1.7 ± 1.1% vs. mitral: 1.9 ± 2.3%; p = 0.227). Aortic valve patients, however, presented with a higher cardiovascular risk profile, including more frequent arterial hypertension (90.6% vs. 81.3%; p = 0.001), diabetes (28.2% vs. 15.7%; p < 0.001), dyslipidemia (59.3% vs. 38.6%; p < 0.001), and peripheral vascular disease (6.9% vs. 0.6%; p = 0.003). Postoperative stroke rates were 1.5% in the aortic group and 1.2% in the mitral group ( p = 0.751). TIA occurred in 0.2% vs. 0.6% ( p = 0.352), delirium in 19.7% vs. 14.8% ( p = 0.139), major vascular access complications in 0.02% vs. 0.0% ( p = 0.986), and femoral wound complications in 2.3% vs. 1.2% ( p = 0.103), with no statistically significant differences. Conclusion: Despite a significantly higher cardiovascular risk profile in the aortic group, the main outcome parameters did not differ significantly from those in the mitral group. Thus, femoral cannulation in the setting of minimally invasive aortic valve surgery can be considered safe. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany