A new cannula for antegrade selective cerebral perfusion

Abstract

Objective: Our aim was to perform antegrade selective cerebral perfusion with a different surgical technique using a new type of cannula.Methods: This cannula has been designed to be introduced in the supra-aortic vessels directly using a standard guidewire technique (Seldinger technique). The cannula can also be inserted from the ostia of a vessel if preferred. Furthermore, this device can be introduced before the institution of hypothermic circulatory arrest and opening the aortic arch.Results: We have performed operations on 5 patients so far using this cannula. No stroke or spinal cord injuries were detected. At the moment, both intraoperatively and at computed tomography scan follow-up, no significant stenosis of the cannulation sites were noted. Follow-up at 2 years found that patients are alive and free from new major neurological events.Conclusions: Transarterial introduction using the Seldinger technique of our cannula (AV Flow; MedEurope Srl, Bologna, Italy) represents an alternative to the current well-established techniques. The major advantages we describe are complete cerebral protection throughout the hypothermic circulatory arrest and easier arch vessels reimplantation or hemiarch operations. (JTCVS Techniques 2020;4:10-3) AV Flow cannula (MedEurope Srl, Bologna, Italy) with guidewire.

Reply: Will the new tool used for cerebral perfusion be able to “keep it simple” or not?

“…Moreover, as previously pointed out, 4 there are relative contraindications for the use of this new cannula in the case of direct involvement and dissection of supra-aortic vessels either for acute and chronic aortic dissections or severe atherosclerotic arches. In summary, as for every new device introduced in the market, the new interesting tool well-described by Venturini and colleagues 5 will prove its effort over time with standardization of care.…”

Commentary: Hammers and nails

“…Venturini and colleagues 1 nicely demonstrate what may prove to be a cleaner technique of providing antegrade cerebral blood flow during arch operations. The AV Flow cannula uses the Seldinger technique and a balloon-occludable tip, which provides nice inflow without need for a vessel-encircling tape.…”

A new tool in the arsenal

“…Adjunctive surgical details have been previously published. 1

Figure 1 The author's original first schematic freehand drawing of the AV Flow cannula.

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