An in vitro evaluation of a new cannula tip design compared with two                 clinically established cannula-tip designs regarding aortic arch vessel perfusion characteristics

The objective of this study was to evaluate five small-bore arterial cannulae (6Fr and 8Fr) in terms of pressure drop and hemodynamic performance in simulated neonatal cardiopulmonary bypass (CPB) circuits. The experimental circuits consisted of a Jostra HL-20 roller pump, a Terumo Capiox Baby FX05 oxygenator with integrated arterial filter, an arterial and a venous tubing (1/4, 3/16, or 1/8 in × 150 cm), and an arterial cannula (Medtronic Bio-Medicus 6Fr and 8Fr, Maquet 6Fr and 8Fr, or RMI Edwards 8Fr). The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates (6Fr: 200-400 mL/min; 8Fr: 200-600 mL/min) and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Higher circuit pressure, circuit pressure drop, and hemodynamic energy loss across the circuit were recorded when using small-bore arterial cannula and small inner diameter arterial tubing in a neonatal CPB circuit. The maximum preoxygenator pressures reached 449.7 ± 1.0 mm Hg (Maquet 6Fr at 400 mL/min), and 395.7 ± 0.4 mm Hg (DLP 8Fr at 600 mL/min) when using 1/8 in ID arterial tubing at 28°C. Hypothermia further increased circuit pressure drop and hemodynamic energy loss. Compared with the others, the RMI 8Fr arterial cannula had significantly lower pressure drop and energy loss. Maquet 6Fr arterial cannula had a greater pressure drop than the DLP 6Fr. A small-bore arterial cannula and arterial tubing created high circuit pressure drop and hemodynamic energy loss. Appropriate arterial cannula and arterial tubing should be considered to match the expected flow rate. Larger cannula and tubing are recommended for neonatal CPB. Low-resistance neonatal arterial cannulae need to be developed.

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“…(3,(7)(8)(9)(10). With a small cannula it is easy to perform aortic cannulation but the cannula cannot provide adequate flow to the entire body.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Hemodynamic Evaluation of Five 6 Fr and 8 Fr Arterial Cannulae in Simulated Neonatal Cardiopulmonary Bypass Circuits

et al. 2015

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“…Experimental and computational bioengineering studies have begun to address these issues, investigating the impact of cannula design [6] and location [7] on perfusion characteristics in normal aortic arches. The recent study of Kauffman et al [7], for example, compares the hemodynamic characteristics of a standard bypass configuration with different cannula insertion points and angles for a healthy aortic arch configuration.…”

Section: Introductionmentioning

confidence: 99%

Cannulation Strategy for Aortic Arch Reconstruction Using Deep Hypothermic Circulatory Arrest

Zélicourt¹,

Jung²,

Horner³

et al. 2012

The Annals of Thoracic Surgery

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Background Aortic arch reconstruction in neonates is commonly performed using deep hypothermic circulatory arrest. However, concerns have arisen regarding potential adverse neurologic outcomes from this complex procedure, raising questions as to best arterial cannulation approach for cerebral perfusion and effective systemic hypothermia. In this study, we use computational fluid dynamics to investigate the impact of different cannulation strategies in neonates. Methods Using a realistic hypoplastic neonatal aorta template as the base geometry, four different cannulation options were investigated: 1) right innominate artery, 2) innominate root, 3) patent ductus arteriosus (PDA), or 4) both innominate root and PDA. Performance was evaluated based on the numerically predicted cerebral and systemic flow distributions compared with physiological perfusion under neonatal conditions. Results The four cannulation strategies were associated with different local hemodynamics, but this did not translate into any significant effect on the measured flow distributions. The largest difference only represented 0.8% of the cardiac output and was measured in the innominate artery, which received 23.2% of the cardiac output in Option 3 vs. 24% in Option 4. PA snaring benefited all systemic vessels uniformly. Conclusion Due to the very high vascular resistances in neonates, flow distribution to the different vascular beds was dictated by the downstream vascular resistances rather than the cannulation strategy, allowing the surgical team to choose their method of preference. However, patients with aortic coarctation warrant further investigation and will most likely benefit from a two cannulae approach (Option 4).

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“…There are many possible reasons for those phenomena, such as embolism (7,8) caused by the cannula jet hitting the aortic wall (9)(10)(11), or manipulation of the aorta by cannulae or clamps (12)(13)(14). Different cannulae have been developed to improve the cerebral perfusion during CPB (15,16). Still, the position of the CPB outflow cannula influences the blood flow in the outgoing arteries and thus end organ perfusion.…”

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confidence: 99%

The Impact of Aortic/Subclavian Outflow Cannulation for Cardiopulmonary Bypass and Cardiac Support: A Computational Fluid Dynamics Study

Kaufmann¹,

Hormes²,

Laumen³

et al. 2009

Artificial Organs

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Approximately 100 000 cases of oxygen deficiency in the brain occur during cardiopulmonary bypass (CPB) procedures each year. In particular, perfusion of the carotid and vertebral arteries is affected. The position of the outflow cannula influences the blood flow to the cardiovascular system and thus end organ perfusion. Traditionally, the cannula returns blood into the ascending aorta. But some surgeons prefer cannulation to the right subclavian artery. A computational fluid dynamics study was initially undertaken for both approaches. The vessel model was created from real computed tomography/magnetic resonance imaging data of young healthy patients. The simulations were run with usual CPB conditions. The flow distribution for different cannula positions in the aorta was studied, as well as the impact of the cannula tip distance to vertebral artery for the subclavian position. The study presents a fast method of analyzing the flow distribution in the cardiovascular system, and can be adapted for other applications such as ventricular assist device support. It revealed that two effects cause the loss of perfusion seen clinically: a vortex under the brachiocephalic trunk and low pressure regions near the cannula jet. The results suggest that cannulation to the subclavian artery is preferred if the cannula tip is sufficiently far away from the branch of the vertebral artery. For the aortic positions, however, the cannula should be injected from the left body side.

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An in vitro evaluation of a new cannula tip design compared with two clinically established cannula-tip designs regarding aortic arch vessel perfusion characteristics

Cited by 16 publications

References 20 publications

In Vitro Hemodynamic Evaluation of Five 6 Fr and 8 Fr Arterial Cannulae in Simulated Neonatal Cardiopulmonary Bypass Circuits

In Vitro Hemodynamic Evaluation of Five 6 Fr and 8 Fr Arterial Cannulae in Simulated Neonatal Cardiopulmonary Bypass Circuits

Cannulation Strategy for Aortic Arch Reconstruction Using Deep Hypothermic Circulatory Arrest

The Impact of Aortic/Subclavian Outflow Cannulation for Cardiopulmonary Bypass and Cardiac Support: A Computational Fluid Dynamics Study

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