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A new double lumen balloon catheter for retrograde cerebral perfusion via jugular vein cannulation
1Second Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamikyoku, Japan.
Insights
A novel catheter enables retrograde cerebral perfusion (RCP) by delivering oxygenated blood into the internal jugular vein (IJV), preventing lower body drainage. This innovation facilitates successful RCP during circulatory arrest, aiding complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Medical Device Innovation
- Cerebrovascular Protection
Background:
- Retrograde cerebral perfusion (RCP) is crucial for protecting the brain during aortic arch surgery.
- Existing methods for RCP face challenges in effectively preventing venous blood drainage.
- A need exists for improved catheter technology to optimize RCP delivery and efficacy.
Purpose of the Study:
- To introduce and evaluate a new catheter designed for enhanced retrograde cerebral perfusion.
- To demonstrate the catheter's ability to deliver blood directly into the internal jugular vein (IJV) and occlude venous drainage.
- To assess the catheter's performance in mock circulatory studies and clinical application.
Main Methods:
- Development of a dual-channel catheter with an integrated occlusion balloon at the tip.
- Insertion via a 14 Fr sheath using standard puncture technique into the IJV.
- Testing in a mock circulatory system to assess pressure-flow dynamics.
- Clinical evaluation during circulatory arrest with profound hypothermia for aortic arch procedures.
Main Results:
- The catheter successfully delivered oxygenated blood into the IJV beyond venous valves, preventing lower body drainage.
- Mock circulatory studies showed increased perfusion line pressure with higher flow rates (0-400 ml/min).
- Clinical use demonstrated effective reduction of blood drainage and successful RCP (300-350 ml/min flow, 15 mmHg IJV pressure) under hypothermic circulatory arrest.
Conclusions:
- The new catheter provides effective retrograde cerebral perfusion by selectively perfusing the IJV and preventing systemic drainage.
- Its design allows for controlled delivery of oxygenated blood, enhancing cerebral protection during cardiac surgery.
- This catheter is a promising tool for facilitating complex procedures like distal arch replacement via left lateral thoracotomy.
Abstract:
A new catheter for retrograde cerebral perfusion (RCP) was developed that can be used to deliver blood directly into the internal jugular vein (IJV) beyond the venous valves at the jugular-subclavian junction and prevent blood from draining into the lower half of the body. This catheter can be inserted into the IJV via a standard puncture technique by use of a 14 Fr sheath. The catheter shaft has two channels for balloon inflation and blood perfusion, respectively. A balloon for occlusion of drainage veins (superior vena cava and azygos vein) is installed at the catheter tip. Side holes, through which oxygenated cold blood is delivered into the IJV, are located 95 mm from the catheter tip. In a mock circulatory study, the pressure at the perfusion line (16-118 mmHg) increased with the increasing flow rate (0-400 ml/min). In clinical application, under circulatory arrest with profound hypothermia, inflation of the balloon effectively reduced blood drainage into the lower half of the body and, consequently, RCP was successfully performed (flow rate, 300-350 ml/min; pressure at the IJV, 15 mmHg). Because all of these procedures were controlled from outside the operative field, RCP by use of this catheter could be useful in distal arch replacement via left lateral thoracotomy.