No Deep Hypothermic Circulatory Arrest In Arch Surgery With Antegrade Transfemoral Perfusion
Ettorino Di Tommaso1, Antonio Mariniello1, Fabio Scigliano1, Immacolata Fontana2, Luigi Di Tommaso1, Gabriele Iannelli1.
1Department of Cardiac Surgery A.O.U. Federico II, Napoli, Italy, 2Department of Anesthesiology A.O.U. Federico II, Napoli, Italy.
Objective: Standard arterial cannulation for CardioPulmonary Bypass is achieved through Ascending Aorta. When aneurysms or dissections involve the ascending aorta and make such vessel fragile and unstable with an important risk of rupture, femoral artery is preferred for cannulation. This cannulation, though, inverts flow in thoraco-abdominal aorta from antegrade to retrograde, leading to possible thrombus displacement towards epiaortic vessels and subsequent strokes. For this reason, femoral cannulation is often replaced by right subclavian/axillary artery cannulation, the latter allowing an antegrade flow. However, this latter solution doesn’t allow thoraco-abdominal perfusion during aortic arch procedures, making mandatory deep hypothermic circulatory arrest (DHCA).
We designed a new cannula in order to achieve antegrade flow in aortic arch and in thoraco-abdominal aorta and to avoid Deep Hypothermic Circulatory Arrest.
Methods: The cannula is a 70 cm or longer, with an inflatable balloon at the distal portion and with tip holes, main central hole and, at least, 4-6 side holes to ensure a 4-5 liters/min flow. The cannula deployment is achieved in two steps of operation: in the first one the cannula is introduced over a stiff guide-wire through the femoral artery and its distal longitudinal end portion is positioned inside the aortic arch and in this arrangement the cannula allows a cardiopulmonary bypass with anterograde blood flow into the aortic arch and thoraco-abdominal aorta (Antegrade Cardio Pulmonary Bypass “ARMY”). In the second step the same cannula moves under the left subclavian artery and, after inflating the balloon, the aortic arch could be opened: in these time the aortic vessels perfusion is guaranteed by Kazui cannulation (Selective Antegrade Thoraco-Abdominal Perfusion “STONE”).
Results: At this time the patent is being approved and there are no results available.
Conclusions: This new cannula could enable to reach an antegrade flow in the whole thoracic aorta (ARMY) and to perfuse the thoraco-abdominal aorta (STONE) without DHCA. In this way, we could decrease the risk of bleeding, pulmonary complications, visceral and/or limb ischemia and contain the risk of paraplegia.
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