Transcript A_Technical consideration (Kittiya)

Technical Consideration
in Arteral Cannulation
for
Thoracic Aortic Surgery
Kittiya Khwanmaung
Prasitchai
Udompornpaiboon
Mongkol
Nuanthong
Ekachai
Juiprasert
Nattapong Chumpol
Naraksak
Vanbouas
Wachiraporn Noinueay
Arpa
Arphaphongphatthara
Yuppadee
Prasansombut
Witsanee
ChokpaisanPerfusionist, Siriraj hospita
Aortic Disease
Aortic aneurysm
An Aortic aneurysm is a
general term for any dilatation of
the aorta to greater than 1.5
times normal usually
representing an underlying
weakness in the wall of the aorta
at that location.
Aortic dissection
Degeneration of
medial layer is
considered to be chief
predisposing factor in
nontraumatic dissection.
The surgical treatment for most aortic
disease require cardiopulmonary bypass
with various cannulation.
Choosing the proper cannulating site
for arterial return is an important point
during the conduct of cardiopulmonary
bypass .
SITE
Cannulation sites
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the prosthesis graft
 Left ventricle apex
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Operations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Innominate artery
cannulation
Advantage : Antegrade cerebral perfusion
DOI:
10.1016/j.athoracsur.2008.03.
044
arterial inflow for CPB.
- The ascending aorta is the usual site of
When disease involves the ascending aorta or the aortic arch, or in
some redo cases, the ascending aortic canulation is unavailable.
Innominate artery
cannulation
Head
Cannula :
Size of Metal tip : 4.5 mm,
5.0 mm
Innominate artery
cannulation
Soft flow : angle 6.0 mm, 7.0
mm
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Axillary artery
cannulation
Advantage : - Antergrade cerebral perfusion
- Safe and reliable (Axillary artery
cannulation is safe and reliable in patients with ascending
aortic disease.)
DOI: 10.1016/j.athoracsur.2006.10.068
- The axillary artery was used as a second choice when no
other cannulation site seemed to be suitable for perfusion.
Axillary artery
cannulation
Axillary artery
cannulation
• Elongated One-Piece Arterial cannular;
EOPA : 22 Fr.
• 8 mm prosthetic side graft anastomosed
to the axillary artery.
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Ascending aorta
cannulation
Advantage : Simple aortic
cannulation is safe, easy and
reproducible.
Head
Ascending aorta
cannulation
Canulars
------------------------ -------------------------Size of Metal tip Select cap:
:
18 Fr., 20 Fr.
4.5 mm, 5.0 mm ----------------------------------------------- --Soft flow :
Soft flow :
6.0 mm, 7.0 mm
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Arch of aorta
Advantage : We can cannulate
above the assending aorta at
arch of aorta.
Arch of aorta
Canular
------------------------ -------------------------Size of Metal tip Select cap:
:
18 Fr., 20 Fr.
4.5 mm, 5.0 mm ----------------------------------------------- --Soft flow :
Soft flow :
6.0 mm, 7.0 mm
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Femoral artery
cannulation
Advantage :
Easy, fast
doi: 10.1161/CIRCULATIONAHA.108.8
- The femoral artery has been the standard cannulation site
for cardiopulmonary bypass in treating acute aortic dissection type A.
Femoral artery
cannulation
Femoral artery
cannulation
 Femoral artery cannula : 15 Fr.,
17 Fr., 19 Fr., 21 Fr.
 Femoral insertion kit
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Side branch of the
prosthesis graft
cannulation
Advantage : Reduced ischemia time lower body
Head
Side branch of the
prosthesis graft
cannulation
 Elongated One-Piece Arterial cannular
(EOPA) : 22 Fr.
 Graft 4 Branch plexus : 10/8/8 x 8 mm.
Direct to the
prosthesis graft
cannulation
Direct to the
prosthesis graft
cannulation
Cannula
- Elongated One-Piece Arterial cannular; EOPA : 18 Fr.,
20 Fr., 22 Fr., 24 Fr.
Locations
 Innominate artery
 Axillary artery
 Ascending aorta
 Arch of aorta
 Descending aorta
 Femoral artery
 Side branch of the
prosthesis graft
 Direct to the
prosthesis graft
 Apical
Transapical aortic
canulation
Advantage :
- Simple and quick cannulation technique
- Sufficient antergrade blood flow
DOI: 10.1016/j.jtcvs.2006.04.016
- Axillary artery cannulation is a good and useful method
but is not always safe or reliable in the presence of acute aortic
dissection. In contrast, transapical aortic cannulation has the
advantage of avoiding these problems, such as antegrade blood
stream, and involves a simpler and quicker cannulation
Transapical aortic
canulation
Transapical aortic
canulation
Cannula
- Elongated One-Piece Arterial cannular; EOPA : 18 Fr.,
20 Fr., 22 Fr., 24 Fr.
Cannulation can be perform at many
sites, but it depends on the pathology of
patient and surgeon preference . It the
preferred cannulation sites ware to the
operation. It will help the operation going on
conveniently , which could provide more
chance to be success.
Than you