New cannulation technique for the severely calcified ascending aorta

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Cardiopulmonary Bypass

Background:

• Standard cardiopulmonary bypass cannulation relies on peripheral arterial access.
• Severe calcific atherosclerosis can obstruct traditional cannulation sites, posing challenges for emergency revascularization.
• Aortic and femoral artery disease are common comorbidities in patients requiring complex cardiovascular interventions.

Observation:

• A patient presented with critical limb ischemia requiring emergency revascularization.
• The patient exhibited severe, diffuse calcific atherosclerosis affecting the femoral arteries, ascending aorta, right subclavian artery, and aortic arch.
• Standard cannulation techniques via the ascending aorta or femoral arteries were deemed impossible due to extensive calcification.

Findings:

• A novel technique involving retrograde cannulation from the left ventricular apex across the aortic valve was successfully employed.
• This approach allowed for the establishment of cardiopulmonary bypass.
• Emergency revascularization was successfully performed using the established bypass.

Implications:

• This left ventricular apex cannulation strategy offers a viable alternative for cardiopulmonary bypass in patients with severe, diffuse atherosclerosis.
• It expands the options for revascularization in complex, high-risk surgical cases.
• This technique may improve outcomes for patients previously deemed inoperable due to vascular limitations.