Central cannulation in pediatric cardiac surgery

The present paper describes the cannulation techniques which are used routinely in our institution. They are established on two basic principles: most operations are performed under full-flow normothermic cardiopulmonary bypass (CPB); deep hypothermic circulatory arrest is avoided. When full-flow conventional CPB is used, cannulation of the ascending aorta and both venae cavae is usually required and should be performed with great caution (with institution of partial bypass as soon as possible) to provide hemodynamic stability during the cannulation process. Additional cannulations and/or technical modifications may be necessary to accommodate frequent associated anomalies (left superior vena cava, systemic or pulmonary venous return anomalies, multiple reoperations). In children requiring aortic arch repair, moderate hypothermia, circulatory arrest and selective cerebral perfusion are used and require specific techniques for arterial cannulation.