Disconnection of the tip of the aortic cannula during cardiopulmonary bypass

Introduction: Cerebral injury is a serious complication in open-heart surgery. Once it occurs, it causes significant disability and death. We developed a novel dispersive aortic cannula named the Stealth Flow cannula and used it as a standard aortic cannula in cardiopulmonary bypass. The aim of this study was to evaluate the efficiency of this aortic cannula. Methods: A total of 182 consecutive patients undergoing cardiac surgery using cardiopulmonary bypass were studied. The patients were divided into two groups: the Soft-Flow cannula group (n = 89) and the Stealth Flow cannula group (n = 93). Patients with a shaggy aortic arch were excluded from this study because the cannulae were inserted at the ascending aorta with a cannula tip directed toward the aortic root in these cases. Patients with multiple arterial perfusion sites were also excluded. Complications including early mortality, perioperative stroke, and intraoperative aortic injury were compared between the two groups. Results: Age, operative procedure, cardiopulmonary bypass time, and the Japan SCORE were not significantly different between the groups. In comparisons between the Stealth Flow and Soft-Flow groups, the incidences of early mortality, perioperative stroke, intraoperative aortic dissection, and all complications were 1.08% versus 1.12% (p = 0.98), 1.1% versus 2.2% (p = 0.53), 0% versus 1.1% (p = 0.33), and 1.1% versus 3.4% (p = 0.29), respectively. The incidence of major cardiovascular events, including early death, perioperative stroke, and aortic dissection, was not different. Conclusions: The Stealth Flow cannula, which was designed based on our previous experimental study, contributed to reducing cerebral and aortic events as much as the Soft-Flow cannula in the present clinical study.

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The Type of Aortic Cannula and Membrane Oxygenator Affect the Pulsatile Waveform Morphology Produced by a Neonate‐Infant Cardiopulmonary Bypass System In Vivo

Artificial Organs ◽

10.1046/j.1525-1594.1998.06017.x ◽

1998 ◽

Vol 22 (8) ◽

pp. 681-686 ◽

Cited By ~ 43

Author(s):

Akif Ündar ◽

Andrew J. Lodge ◽

Casey W. Daggett ◽

Thomas M. Runge ◽

Ross M. Ungerleider ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Membrane Oxygenator ◽

Aortic Cannula

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Quantification and Distribution of Cerebral Emboli during Cardiopulmonary Bypass in the Swine

Anesthesiology ◽

10.1097/00000542-199901000-00024 ◽

1999 ◽

Vol 90 (1) ◽

pp. 183-190 ◽

Cited By ~ 42

Author(s):

Walter Plochl ◽

David J. Cook

Keyword(s):

Blood Flow ◽

Cardiopulmonary Bypass ◽

Ocular Blood Flow ◽

Fluorescent Microspheres ◽

Tissue Samples ◽

Blood Flows ◽

Cerebral Embolization ◽

Before And After ◽

Aortic Cannula ◽

The Brain

Background Patients undergoing cardiac surgery have a substantial incidence of neurologic complications related to cerebral embolization during cardiopulmonary bypass. The purpose of this study was to determine if adjustments in the arterial carbon dioxide (PaCO2) level can reduce cerebral and ocular embolization. Methods Twenty pigs underwent cardiopulmonary bypass at 38 degrees C. At either hypercarbia (PaCO2 = 50-55 mmHg, group H, n = 10) or hypocarbia (PaCO2 = 25-30 mmHg, group L, n = 10), an embolic load of 1.2 x 10(50 67-microm orange fluorescent microspheres was injected into the aortic cannula. Before and after embolization, cerebral and ocular blood flows were determined at normocapnia using 15-microm fluorescent microspheres. After cardiopulmonary bypass was completed, the eyes were enucleated and brain tissue samples were collected. Microspheres were isolated and the fluorescence was measured. Results In groups H and L, the mean PaCO2 values at embolization were 52+/-3 mmHg and 27+/-2 mmHg, respectively (P < 0.0001). Total and regional embolization were significantly less in hypocapnia than in hypercapnic animals: 142% more emboli were detected in the brain in group H than in group L (P < 0.0001). Cerebral blood flow after embolization was unchanged in both groups. Similarly, fewer ocular emboli occurred in hypocapnic animals than in hypercapnic animals (P = 0.044), but in contrast to the brain, ocular blood flow decreased significantly in both groups after embolization. Conclusions Cerebral embolization is determined by the PaCO2 at the time of embolization. In cardiopulmonary bypass practice, reductions in PaCO2 during periods of embolic risk may reduce the risk for brain injury.

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Design of a Physiologic Pulsatile Flow Cardiopulmonary Bypass System for Neonates and Infants

The International Journal of Artificial Organs ◽

10.1177/039139889601900306 ◽

1996 ◽

Vol 19 (3) ◽

pp. 170-176 ◽

Cited By ~ 11

Author(s):

A. Ündar ◽

T.M. Runge ◽

O.L. Miller ◽

M.C. Felger ◽

R. Lansing ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Pulsatile Flow ◽

Surgical Techniques ◽

Primary Objective ◽

Extracorporeal Circuit ◽

Mean Pressure ◽

Extracorporeal Circuits ◽

Aortic Cannula

Cardiopulmonary bypass surgical techniques that allow a surgeon to operate on the infant's heart use an extracorporeal circuit consisting of a pump, oxygenator, arterial and venous reservoirs, cannulae, an arterial filter, and tubing. The extracorporeal technique currently used in infants and neonates is sometimes associated with neurologic damage. We are developing a modified cardiopulmonary bypass system for neonates that has been tested in vitro and in one animal in vivo. Unlike other extracorporeal circuits which use steady flow, this system utilizes pulsatile flow, a low prime volume (500ml) and a closed circuit. During in vitro experiments, the pseudo patient's mean arterial pressure was kept constant at 40 mmHg and the extracorporeal circuit pressure did not exceed a mean pressure of 200 mmHg. In our single in vivo experiment, the primary objective was to determine whether physiologic pulsatility with a 10F (3.3 mm) aortic cannula could be achieved. The results suggest that this is possible.

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Effect of aortic cannula characteristics and blood velocity on transcranial doppler-detected microemboli during cardiopulmonary bypass

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/s1053-0770(98)90003-9 ◽

1998 ◽

Vol 12 (3) ◽

pp. 266-269 ◽

Cited By ~ 10

Author(s):

Mark Benaroia ◽

Andrew J. Baker ◽

C.David Mazer ◽

Lee Errett

Keyword(s):

Cardiopulmonary Bypass ◽

Transcranial Doppler ◽

Blood Velocity ◽

Aortic Cannula

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Heart valve inspired and multi‐stream aortic cannula: Novel designs for cardiopulmonary bypass improvement in neonates

Artificial Organs ◽

10.1111/aor.13462 ◽

2019 ◽

Vol 43 (10) ◽

Cited By ~ 1

Author(s):

Reza Rasooli ◽

Kerem Pekkan

Keyword(s):

Cardiopulmonary Bypass ◽

Heart Valve ◽

Aortic Cannula

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Aortic cannula orientation and flow impacts embolic trajectories: computational cardiopulmonary bypass

Perfusion ◽

10.1177/0267659119889777 ◽

2019 ◽

Vol 35 (5) ◽

pp. 409-416

Author(s):

Raymond Ho ◽

Charles McDonald ◽

Jo P Pauls ◽

Zhiyong Li

Keyword(s):

Cardiopulmonary Bypass ◽

Numerical Study ◽

Ascending Aorta ◽

Brachiocephalic Artery ◽

Final Position ◽

Forward Flow ◽

Aortic Cannula ◽

Lesser Curvature ◽

The Impact ◽

Aortic Branch

Introduction: Emboli events are associated with the aortic cannula insertion and final position in the ascending aorta. However, the impact of subtle changes in aortic cannula movement and flow influencing embolic transport throughout the aortic arch is not well understood. The present study evaluated the aortic cannula’s outflow and orientation effect on emboli entering the aortic branch arteries. Methods: A simplified aortic computational model was anteriorly cannulated in the distal ascending aorta with a 21-French straight aortic cannula, and two orientations were analysed by injecting gaseous and solid emboli at pump flows 2, 3 and 5 L/minute. The first aortic cannula orientation (forward flow cannula) was directed towards the lesser curvature. The second aortic cannula orientation (rear flow cannula) was tilted slightly backwards by 15°, providing flow in the retrograde direction. Results: Forward flow cannula produced a primary arch flow, whereas rear flow cannula produced a secondary arch flow resulting in four times longer emboli arch resident times than forward flow cannula. The rear flow cannula had the highest percentage of gaseous emboli entering the brachiocephalic artery of 8%, 12% and 36% (at 2, 3 and 5 L/minute, respectively). Rear flow cannula provided a positive aortic branch arterial flow at all pump flows, whereas at forward flow cannula, the brachiocephalic artery experienced retrograde flows of −1.0% (3 L/minute) and −4.0% (5 L/minute), with the left common carotid −0.23% (5 L/minute). No significant number of solid emboli entered the aortic branch arteries. Conclusion: This numerical study illustrated distinct trajectory behaviours between gaseous and solid emboli where slight changes in aortic cannula orientation influenced idealised emboli direction with higher pump flows magnifying the effects.

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An Alternative and Safer Method for Aortic Decannulation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300123 ◽

2005 ◽

Vol 13 (1) ◽

pp. 88-89

Author(s):

Maninder S Kalkat ◽

Jitender M Parmar

Keyword(s):

Cardiopulmonary Bypass ◽

Alternative Method ◽

Aortic Cannula

The removal of an aortic cannula at the termination of cardiopulmonary bypass is occasionally associated with complications like bleeding, atheroembolism and dissection. An alternative method to decannulate using a side-biting non-crushing clamp is suggested to mitigate against these complications.

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