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How-to-do-it

Double-arterial cannulation for aortic valve replacement with porcelain aorta

Division of Cardiac Surgery, European Hospital, via Portuense, 700, 00149 Rome, Italy

Received 10 April 2009; received in revised form 6 June 2009; accepted 10 June 2009.

^_* Corresponding author. Tel.: +39 0665975224; fax: +39 0665975112. (Email: depauli{at}tin.it).

We describe a new technique of aortic valve replacement (AVR) in patients with porcelain aorta. Three patients (mean age 75 years) were treated. The cardiopulmonary bypass (CPB) was established after side-graft right axillary artery and direct femoral artery cannulation. Venous drainage was obtained by atrio-caval cannulation. The procedures were performed in mild hypothermia (30 °C). Cerebral perfusion was carried out by clamping the innominate artery and all epiaortic vessels. The aorta was endoclamped by a Foley balloon inserted into the isthmus. The aorta was then opened longitudinally for 10 cm to expose and replace the aortic valve. Near-infra-red spectroscopy (NIRS) and bilateral radial artery pressure were used to monitor effective cerebral perfusion. Operative mortality was absent. The mean time of CPB was 73 min. NIRS-derived tissue oxygenation was maintained above 55%. Postoperative course was uneventful. This technique has several advantages: first, the cannulation of right axillary and the common femoral artery allows simultaneous cerebral and systemic perfusion. Second, any form of cross-clamp is avoided and the aorta is occluded away from the epiaortic vessels. Third, there is an increased freedom to choose the best place for aortotomy.

Key Words: Aortic valve replacement • Porcelain aorta • Cardiopulmonary bypass