Cannulation in the diseased aorta: a safe approach using the Seldinger technique

Area of Science:

• Cardiovascular Surgery
• Vascular Access Techniques
• Cardiopulmonary Bypass

Background:

• The Seldinger technique is established for femoral cannulation in cardiopulmonary bypass.
• Direct ascending aortic cannulation using this technique for antegrade perfusion is not well-documented.
• Retrograde perfusion carries risks like atheromatous embolization in specific patient conditions.

Purpose of the Study:

• To describe a novel approach for direct ascending aortic cannulation using the Seldinger technique.
• To present a safe alternative for antegrade perfusion in patients with challenging aortic anatomy.
• To reduce complications associated with retrograde perfusion.

Main Methods:

• Direct puncture of the ascending aorta using an arterial entry catheter.
• Insertion of a soft-tip guidewire through the catheter.
• Advancement of an aortic cannula over the guidewire, guided by transesophageal echocardiography.
• Positioning the cannula tip in the descending aorta to minimize embolization.

Main Results:

• Successful cannulation of the ascending aorta via the Seldinger technique was achieved.
• The described method is applicable in cases of calcified ascending aorta, aortic dissection, or diseased thoracoabdominal aorta.
• Improved cerebral protection is anticipated due to reduced arterial embolization.

Conclusions:

• The Seldinger technique provides a viable method for direct ascending aortic cannulation for antegrade perfusion.
• This approach is particularly beneficial in patients unsuitable for traditional retrograde perfusion.
• Alternative cannulation sites include the transverse aortic arch or proximal descending aorta if ascending aorta access is not feasible.