Objective: Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. Methods: A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016–2018. Right side femoral artery and femoral vein are used for bypass route. We set cardiopulmonary bypass flow to 2.5–3.0 L/min/m2, and adjust pump flow rate to achieve adequate cerebral oxygenation. The upper limit of arterial cannula pressure was 250 mmHg. We divided our patients into four groups by average pump flow 2.2 L/min/m2 and average mean arterial pressure 45 mmHg. Compared outcomes included surgical mortality, hospital stay, ventilator use, neurological outcomes, acute kidney injury, distal limb saturations, and post-operative clinical complications. Results: We included 117 patients in this study, and all participants had successful mitral valve repair or replacement. Our longest CPB duration was 210 minutes. Surgical mortality was 1.7%. Hemorrhagic stroke rate was 1.7%, and there was no ischemic stroke event. CPB flow did not affect survival rate, hospital stay, intensive care unit stay, or serum lactate in post-operative day 1, but serum creatinine (mg/dL) level increased transiently in patients with low pump flow group(0.9 ± 0.4 vs 1.3 ± 0.7,p
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