Intra-abdominal Versus Descending Thoracic Cannulation Techniques for Abdominal Normothermic Regional Perfusion

Abdominal normothermic regional perfusion (A-NRP) is postmortem perfusion of organs in the abdominal cavity and can be performed using multiple approaches, including femoral, intra-abdominal, and thoracic. Our program began with surgeons performing intra-abdominal cannulations with mechanical or balloon occlusion of the descending thoracic aorta for A-NRP procedures. Recently, we developed a novel technique using the descending thoracic aorta for arterial cannulation with right atrial venous drainage.

All A-NRP cases performed by Regional Perfusion Services from July 1, 2024, to June 30, 2025, were retrospectively reviewed. Intraoperative parameters were collected for comparison.

During the study period, 28 intra-abdominal normothermic regional perfusion (IA-NRP) cannulations and 47 descending thoracic normothermic regional perfusion (DT-NRP) cannulations were performed by 16 surgeons. Median cannulation time was shorter in the DT-NRP cohort (8.5 versus 10.0 min; P = 0.016). Median time on NRP was shorter in the IA-NRP cohort (61.5 versus 91.0 min; P = 0.006). The median decrease in lactate was larger in the DT-NRP cohort (2.9 versus 2.3 mmol/dL; P = 0.024). The median number of transfusions used was higher in the IA-NRP cohort (3.0 versus 0.0; P < 0.001). The learning curves show a quicker descent in time and a lower nadir for the DT-NRP cases, indicating this technique may have a quicker learning curve and be a more efficient approach to cannulation.

DT-NRP cannulation can be implemented for A-NRP with a quick learning curve, providing an additional cannulation option to the IA-NRP approach.