Cannula Selection and Cannulation Techniques for Nonpulsatile Mechanical Ventricular Assistance

Abstract

The successful use of mechanical ventricular assistance is, in large part, dependent upon easy insertion of well designed inflow and outflow cannulas. This manuscript describes a family of cannulas specifically designed for use in a nonpulsatile ventricular assist device (VAD) circuit. Although a variety of commercially available cannulas can be employed in a nonpulsatile VAD circuit, the cannulas described in this manuscript possess a number of unique design features. The reinforced thin-walled design and end hole construction optimize fluid flow characteristics in both the inflow and outflow cannula. The extended length allows the cannulas to transverse the skin at a point far distant from the mediastinum, reducing the potential for ascending cannula site infection. The purpose of this manuscript is not to review all cannulas available for nonpulsatile VAD circuits, but rather to describe in detail a family of cannulas that are ideal VAD cannulas based on their design characteristics. In addition individual cardiac surgeons implant very few of these devices annually. Thus the advantages and disadvantages of common cannulation sites and a proven technique for cannula insertion will also be presented.

Integrated long‐term multifunctional pediatric mechanical circulatory assist device

“…Positioning the VAD above the diaphragm also eliminates the need to surgically insert holes into the diaphragm for cannulae insertion. Standard cannulae diameters and bend angles were used based on reported literature values for clinical implanted VADs 24‐26 . We employed 3‐D computer aided software to reconstruct thoracic anatomy, and we estimated that a VAD with a height ranging between 50 and 70 mm and diameter ranging between 20 and 30 mm could fit above the diaphragm.…”

“…Standard cannulae diameters and bend angles were used based on reported literature values for clinical implanted VADs. [24][25][26] We employed 3-D computer aided software to reconstruct thoracic anatomy, and we estimated that a VAD with a height ranging between 50 and 70 mm and diameter ranging between 20 and 30 mm could fit above the diaphragm. These dimensions were found to somewhat limit the orientation of the device; the design attribute whereby the pumps share the same inflow and outflow domains provided versatility to ensure anatomic fit.…”

Transaortic Inflow and Outflow Cannula for Centrifugal Mechanical Assistance

“…Inflow and ouflow cannulas' designs determine the facility of institution and efficacy of ventricular support with different ventricular assist devices (2). Cannulas designed for standard CPB can be used for connection to the centrifugal pumps in most cases of postcardiotomy cardiogenic shock, which are usually diagnosed in the operating room prior to complete removal of cannulas or sternal closure.…”

The intra-aortic cannula pump: A novel assist device for the acutely failing heart

“…[5][6][7][8] However, the application of these devices usually requires a surgical procedure and involves significant morbidity. [9][10][11] The intra-aortic cannula pump (IACP) is a catheter pump (Hemodynamics LTD, Upper Yoqneam, Israel) designed to support the failing heart by expelling blood in a pulsatile flow pattern from the left ventricle into the ascending aorta. It can be introduced by various approaches.…”