Extracorporeal circulation without external clamping and cannulation of the aorta: transventricular placement of a new multifunctional aortic cannula.

Background: Stroke is a devastating outcome of coronary artery bypass grafting (CABG). An atherosclerotic ascending aorta is a major risk factor for plaque detachment during cannulation and external clamping in patients undergoing CABG while on extracorporeal circulation (ECC). To avoid external cannulation and clamping we developed and tested a new multifunctional cannula in a pig model.

Methods: The cannula has a double-balloon endoclamping function and is placed via the apex of the left ventricle through the aortic valve in the ascending aorta. It has 2 integrated lines for cardioplegic solution and for venting the left ventricle. In this animal model, a single balloon cannula was used because of the short ascending aorta in pigs.

Results: The cannula was placed smoothly and reproducibly with a guide-wire technique. The cardioplegic solution was administered via aortic root perfusion. Weaning from ECC was uneventful, and macroscopic examination did not reveal any damage to the aortic valve.

Conclusions: This cannula could be used in patients with a severe atherosclerotic ascending aorta. The risk of plaque detachment and stroke during ECC might be reduced.