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Selective aortic arch perfusion: a first-in-human observational cadaveric study.

Max Marsden^1,2, Jon Barratt^2,3, Helen Donald-Simpson⁴

¹Blizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

|December 13, 2023

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Selective aortic arch perfusion (SAAP) is a new technique for perfusing the brain and heart during aortic procedures. This study shows SAAP is feasible in humans, with potential for coronary artery access.

Area of Science:

Cardiovascular Surgery
Endovascular Techniques
Medical Device Innovation

Background:

Selective aortic arch perfusion (SAAP) is an emerging endovascular technique combining thoracic aortic occlusion with extracorporeal perfusion of the brain and heart.
SAAP shows potential for treating hemorrhagic shock and cardiac arrest due to coronary ischemia, supported by animal studies.
No human data currently exists for SAAP, necessitating feasibility studies.

Purpose of the Study:

To assess the feasibility of performing selective aortic arch perfusion (SAAP) in humans.
To evaluate the potential of the SAAP catheter for direct coronary artery access, enabling salvage percutaneous coronary intervention.

Main Methods:

A prototype SAAP catheter was inserted into the descending aorta via femoral access in perfused human cadavers.

Keywords:

Cardiac arrest Endovascular Resuscitation SAAP Trauma

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Fluoroscopic guidance was used for catheter insertion and balloon inflation to achieve aortic arch perfusion.

Coronary arteries were cannulated through the SAAP catheter for assessment.

Main Results:

The SAAP catheter was successfully inserted and aortic arch perfusion achieved in two of four trials.
The SAAP catheter demonstrated successful cannulation of the left coronary system in one trial.
A device failure occurred during one of the four procedural attempts.

Conclusions:

This study, using a perfused cadaveric model, demonstrates the initial feasibility and safety of inserting a SAAP catheter and achieving SAAP.
Conventional endovascular techniques can be used for SAAP catheter insertion and deployment.
The SAAP catheter facilitates access to the proximal aorta, enabling retrograde perfusion of coronary and cerebral circulations.