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Peripheral cannulation for cardiopulmonary bypass.

Ludwig K von Segesser1

  • 1Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, CCV, BH 10-275, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

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Summary

Remote cannulation offers renewed benefits for cardiopulmonary bypass in complex surgeries and unstable patients. This review details various peripheral cannulation techniques for arterial and venous access.

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Area of Science:

  • Cardiovascular Surgery
  • Medical Devices
  • Vascular Access

Background:

  • Peripheral cannulation was the historical method for cardiopulmonary bypass.
  • Central cannulation is now standard for most open heart procedures.
  • There is a resurgence in interest in remote cannulation techniques.

Purpose of the Study:

  • To review the techniques and applications of remote cannulation.
  • To highlight the advantages of peripheral cannulation in specific patient populations and complex surgeries.
  • To describe various femoral arterial and venous cannulation methods.

Main Methods:

  • Review of standard and percutaneous cannulation techniques for femoral artery and vein.
  • Discussion of advanced cannula designs for optimized venous cannulation.
  • Exploration of applications in hemodynamically unstable patients and complex aortic procedures.

Main Results:

  • Remote cannulation enables cardiopulmonary bypass in local anesthesia for unstable patients.
  • It is crucial for thoracoabdominal aortic replacement, acute aortic dissections, and redo surgeries.
  • Peripheral cannulation is increasingly used in minimally invasive, robotic, and extracorporeal membrane oxygenation (ECMO) contexts.

Conclusions:

  • Remote cannulation techniques are vital for specific complex cardiovascular procedures.
  • Peripheral access provides critical options for patient stabilization and surgical access.
  • Advancements in cannula design enhance the efficacy of remote cannulation strategies.