Double aortic central cannulation for open thoracoabdominal aorta repair

Abstract

Establishment of extracorporeal circulation during open descending and thoracoabdominal aorta repair is necessary in almost all patients. Full cardiopulmonary bypass (CPB) with peripheral cannulation and left heart bypass are the most commonly used circulatory support strategies and they effectively minimize the risk of visceral and central nervous system ischemia. However, both strategies are associated with significant drawbacks. In this video tutorial we present 2 cases demonstrating an alternative strategy for CPB establishment during descending or thoracoabdominal aortic repair. This technique uses two simultaneous (proximal and distal) aortic perfusion cannulas and a single-stage right atrial cannula, both inserted through the main incision. This technique offers all the advantages of full CPB while lowering the risk of proximal hypoperfusion syndrome, and the use of central cannulas virtually eliminates the risk of retrograde perfusion. Complications associated with femoral incision/cannulation are avoided and excellent venous drainage is achieved. This alternative CPB strategy increases the surgical options for extensive thoracoabdominal aortic repair and allows bespoke management for this complex disease.