J Thorac Cardiovasc Surg 2007;133:1121
© 2007 The American Association for Thoracic Surgery
Apical cannulation for aortic perfusion
Francis Robicsek, MD, PhD
Department of Thoracic and Cardiovascular Surgery, The Carolinas Heart Institute, Carolinas Medical Center, Charlotte, NC
To the Editor:
I read with interest the article, "Transapical aortic cannulation for cardiopulmonary bypass in type A atortic dissection operations," by Wada and associates1
in the November 2006 issue of the Journal. I agree with the authors that this time-tested method is indeed most suitable and safe in the management of type A aortic dissections. However, its applicability may be further enhanced by two additional maneuvers: The first technique is use of a special double-lumen catheter; the larger-caliber channel should have an apical port for perfusion and the shorter, smaller-caliber channel should have a port located about 10 cm proximal to the tip and be positioned in the left ventricle for removal of blood, which may be seeping into the left side of the heart. This arrangement eliminates the need for a separate vent through the right pulmonary vein as applied by the authors. The second technique is application of a "special" aortic crossclamp, the padded jaws of which hermetically occlude the aortic lumen but allow passage of the perfusion catheter.2 This arrangement provides added versatility to apical perfusion, making continuous or intermittent arch perfusion possible even with the proximal aorta open (Figure 1).
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Figure 1. Application of the special "double-padded" clamp and perfusion cannula. The jaws of the instrument may be brought into a position to fully occlude the clamped aorta but still allow the passage of the unobstructed flow through the intra-aortic cannula. The double-barreled cannula allows perfusion through the larger, longer channel tip, which is placed into the aorta, and venting through the shorter, smaller channel, which terminates within the left ventricle. (From Robicsek F. Apical aortic cannulation: Application of an old method with new paraphernalia. Ann Thorac Surg. 1991;51:330-32. Reproduced with permission from The Society of Thoracic Surgeons).
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The issue of bleeding that the authors experienced while placing a purse-string suture into the apex may be effectively addressed by introducing the perfusion catheter through a simple stab wound and placing a 3-pledgeted purse-string suture after the heart is cold and fully relaxed.
The authors’ addition transesophageal echo control of the catheter placement adds additional safety to the method.
References
- Wada S, Yamamoto S, Honda J, Hiramoto A, Wada H, Hosoda Y. Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations. J Thorac Cardiovasc Surg 2006;132:369-372.[Abstract/Free Full Text]
- Robicsek F. Apical aortic cannulation: application of an old method with new paraphernalia. Ann Thorac Surg 1991;51:330-332.[Abstract/Free Full Text]
