Conversion From Routine CPB to Centrifugal Mechanical Assist by Transaortic Inflow Cannulation of the Left Ventricle

Kalangos, Afksendiyos; Murith, Nicolas Paul Henri; Baldovinos, Ary; Faidutti, B

doi:10.1016/s0003-4975(98)00145-3

Cited by 4 publications

(8 citation statements)

References 3 publications

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“…Improved washout (i.e., higher EF) was also noted in the right ventricle in our study with RVC, thus potentially reducing the risk of thrombus formation in the heart chamber. This choice, however, is often dependent on the preference of the surgeon and can be limited by anatomical constraints or the preoperative presence of thrombus within a vessel (6,7). This is, however, not possible in RAC, and right ventricular ejection is confined solely through the pulmonary valve.…”

Section: Discussionmentioning

confidence: 99%

“…The choice of inflow cannulation site is often dependent on the cannula design or preference of the surgeon and can be limited by anatomical constraints or the presence of thrombus within the heart chambers (6,7). Outflow cannulation is generally achieved through the ascending aorta (LVAD) and the anterior aspect of the pulmonary artery (RVAD).…”

mentioning

confidence: 99%

“…The VAD inflow cannulation site represents the primary interface between patient and device, and position of the cannula in either the atrium or ventricle induces major hemodynamic changes. The choice of inflow cannulation site is often dependent on the cannula design or preference of the surgeon and can be limited by anatomical constraints or the presence of thrombus within the heart chambers (6,7).…”

mentioning

confidence: 99%

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Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Gregory

Pearcy

Timms³

2013

Artificial Organs

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Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33 L/min, RVC: 1.97 L/min) and lower right ventricular stroke work (RAC: 0.10 W, RVC: 0.13 W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Gregory

Pearcy

Timms³

2013

Artificial Organs

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“…[21][22][23] These devices typically pump blood through a cannula placed across the functioning aortic valve, also if the pump itself is placed extracorporeally. 24,25 However, miniaturization of VADs allows direct implantation into the cardiac chamber and allows the use of these pumps as conventional VADs with the outflow cannula passing through the aortic valve. 6 For transvalvular devices, the interaction with the aortic valve and especially centering in the aortic orifice seems to play an important role.…”

Section: E151mentioning

confidence: 99%

“…These devices typically pump blood through a cannula placed across the functioning aortic valve, also if the pump itself is placed extracorporeally . However, miniaturization of VADs allows direct implantation into the cardiac chamber and allows the use of these pumps as conventional VADs with the outflow cannula passing through the aortic valve …”

Section: Introductionmentioning

confidence: 99%

Dynamic measurement of centering forces on transvalvular cannulas

et al. 2019

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In heart failure therapy, minimally invasive devices (transcatheter valves, catheter‐based cannulas or pumps) are increasingly used. The interaction with the valve is of special importance as valve damage, backflow, and thrombus formation are known complications. Therefore, the aim of this in vitro study was to characterize the forces acting on different sized transvalvular cannulas at various transvalvular pressures for four different valves. In a pulsatile setup radial and tangential forces on transvalvular cannulas were measured for bioprosthetic, artificial pericardial tissue, fresh, and fixated porcine valves. The cannula position was varied from a central position to the wall in 10° rotational steps for the whole circular range and the use of different cannula diameters (4, 6, and 8 mm) and transvalvular pressures (40‐100 mmHg). Centering forces of four different aortic valve types were identified and the three leaflets were visible in the force distribution. At the mid of the cusps and at the largest deflection the forces were highest (up to 0.8 N) and lowest in the commissures (up to 0.2 N). Whereas a minor influence of the cannula diameter was found, the transvalvular pressure linearly increased the forces but did not alter the force patterns. Centering forces that act on transvalvular cannulas were identified in an in vitro setup for several valves and valve types. Lowest centering forces were found in the commissures and highest forces were found directly at the cusps. At low pressures, low centering forces and an increased cannula movement can be expected.

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Transaortic Inflow and Outflow Cannula for Centrifugal Mechanical Assistance

Kalangos

2000

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A specific cannula allowing single site transaortic inflow and outflow cannulation for centrifugal assist devices is described. The cannula is inserted through a straight 18 mm collagen coated Dacron tube anastomosed to the anterior aspect of the ascending aorta. The inflow conduit of the cannula is positioned into the left ventricle through the aortic valve, and the end hole of the outflow conduit is positioned in the ascending aorta. The cannula was evaluated in vivo in 3 adult pigs by the institution of a centrifugal pump for left ventricular support. Optimal flow varied between 5 and 6 L/min and mean aortic pressure between 55 and 70 mm Hg throughout the 3 days of left ventricular support. Recently, we employed this cannula in a patient who was not able to be weaned from cardiopulmonary bypass for the institution of left ventricular support using a centrifugal pump. The cannula provided effective inflow and outflow drainage with an optimal flow of 5.2 L/min throughout the 72 h of support. The patient was successfully weaned from support on the fourth postoperative day. This rational transaortic approach of cannulation using this specific cannula is a refined implantation technique which allows direct left ventricular inflow drainage, reduces the time of implantation, spares left ventricular myocardium, avoids bleeding that is sometimes encountered at other cannulation sites, and avoids compression of the heart by cannulas.

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Conversion From Routine CPB to Centrifugal Mechanical Assist by Transaortic Inflow Cannulation of the Left Ventricle

Cited by 4 publications

References 3 publications

Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Evaluation of Inflow Cannulation Site for Implantation of Right‐Sided Rotary Ventricular Assist Device

Dynamic measurement of centering forces on transvalvular cannulas

Transaortic Inflow and Outflow Cannula for Centrifugal Mechanical Assistance

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