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The impact of aortic/subclavian outflow cannulation for cardiopulmonary bypass and cardiac support: a computational
Tim A S Kaufmann1, Marcus Hormes, Marco Laumen
1Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany. kaufmann@hia.rwth-aachen.de
Insights
Cardiopulmonary bypass (CPB) can cause brain oxygen deficiency. Optimizing cannula position, particularly in the subclavian artery, can improve blood flow and reduce risks during CPB procedures.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Medical Imaging
Background:
- Each year, approximately 100,000 brain oxygen deficiency cases occur during cardiopulmonary bypass (CPB).
- Perfusion to the carotid and vertebral arteries is particularly vulnerable during CPB.
- The outflow cannula's position significantly impacts end-organ perfusion and cardiovascular blood flow.
Purpose of the Study:
- To analyze the influence of outflow cannula position on cerebral perfusion during CPB.
- To compare aortic versus right subclavian artery cannulation strategies.
- To identify flow dynamics contributing to brain hypoperfusion during CPB.
Main Methods:
- Computational fluid dynamics (CFD) simulations were performed using patient-specific imaging data (CT/MRI).
- Flow distribution and pressure dynamics were analyzed for various aortic and right subclavian artery cannula positions.
- The impact of cannula tip proximity to the vertebral artery was assessed for subclavian cannulation.
Main Results:
- Two primary mechanisms causing hypoperfusion were identified: a vortex under the brachiocephalic trunk and low-pressure regions near the cannula jet.
- Cannulation of the right subclavian artery is preferable when the cannula tip is adequately distanced from the vertebral artery origin.
- For aortic cannulation, optimal flow is achieved when the cannula is inserted from the left side.
Conclusions:
- Cannula positioning is critical for maintaining adequate cerebral perfusion during CPB.
- Right subclavian artery cannulation offers a potentially safer alternative to aortic cannulation under specific placement conditions.
- CFD modeling provides a valuable tool for optimizing surgical strategies and device design in CPB and ventricular assist device support.
Abstract:
Approximately 100 000 cases of oxygen deficiency in the brain occur during cardiopulmonary bypass (CPB) procedures each year. In particular, perfusion of the carotid and vertebral arteries is affected. The position of the outflow cannula influences the blood flow to the cardiovascular system and thus end organ perfusion. Traditionally, the cannula returns blood into the ascending aorta. But some surgeons prefer cannulation to the right subclavian artery. A computational fluid dynamics study was initially undertaken for both approaches. The vessel model was created from real computed tomography/magnetic resonance imaging data of young healthy patients. The simulations were run with usual CPB conditions. The flow distribution for different cannula positions in the aorta was studied, as well as the impact of the cannula tip distance to vertebral artery for the subclavian position. The study presents a fast method of analyzing the flow distribution in the cardiovascular system, and can be adapted for other applications such as ventricular assist device support. It revealed that two effects cause the loss of perfusion seen clinically: a vortex under the brachiocephalic trunk and low pressure regions near the cannula jet. The results suggest that cannulation to the subclavian artery is preferred if the cannula tip is sufficiently far away from the branch of the vertebral artery. For the aortic positions, however, the cannula should be injected from the left body side.
