A1 Refereed original research article in a scientific journal
Safety of direct true lumen cannulation after venous exsanguination: a study in a surviving porcine model
Authors: Mustonen C, Honkanen HP, Lehtonen S, Tuominen H, Makela T, Kaakinen T, Yannopoulos F, Anttila V, Juvonen T
Publisher: Oxford University Press
Publication year: 2019
Journal: European Journal of Cardio-Thoracic Surgery
Journal name in source: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Journal acronym: EUR J CARDIO-THORAC
Volume: 56
Issue: 3
First page : 451
Last page: 457
Number of pages: 7
ISSN: 1010-7940
DOI: https://doi.org/10.1093/ejcts/ezz047
Abstract
OBJECTIVES: Type A aortic dissection requires immediate surgery. Traditional cannulation methods such as the central aortic cannulation with the Seldinger technique and axillary cannulation are primary choices. Yet in the presence of tamponade or severe cardiogenic shock, these can be too time-consuming to complete. Direct true lumen cannulation after venous exsanguination not only avoids this issue but also leads to transient global ischaemia. We studied the safety of direct true lumen cannulation from the aspect of global ischaemia in a surviving porcine model.METHODS: Twelve pigs were randomized to either control or intervention groups (6 + 6). The intervention group underwent simulated direct true lumen cannulation by exsanguination and circulatory arrest for 5 min at 35 degrees C before cardiopulmonary bypass (CPB). Both groups underwent CPB cooling to 25 degrees C followed by a 25-min arrest period and subsequent warming to 36 degrees C. Neuron-specific enolase levels were measured at 6 time-points from blood samples. Near-infrared spectroscopy was used to determine brain oxygenation. The neurological recovery was evaluated daily during a 7-day follow-up, and the brain was harvested for a histopathological analysis after euthanization.RESULTS: All pigs recovered their normal neurological behaviour. The neurobehavioural total score on postoperative day 2 reached borderline statistical significance, thus favouring the intervention group [(9 (8.75-9) vs 6.5 (5.5-9), P = 0.06]. Near-infrared spectroscopy values and neuron-specific enolase levels slightly favoured the control group during the cooling period, but the difference was not clinically significant. The histopathological analysis showed no difference between the groups.CONCLUSIONS: A 5-min period of normothermic global ischaemia before CPB does not impair the neurological outcome following hypothermic circulatory arrest in a surviving porcine model.
OBJECTIVES: Type A aortic dissection requires immediate surgery. Traditional cannulation methods such as the central aortic cannulation with the Seldinger technique and axillary cannulation are primary choices. Yet in the presence of tamponade or severe cardiogenic shock, these can be too time-consuming to complete. Direct true lumen cannulation after venous exsanguination not only avoids this issue but also leads to transient global ischaemia. We studied the safety of direct true lumen cannulation from the aspect of global ischaemia in a surviving porcine model.METHODS: Twelve pigs were randomized to either control or intervention groups (6 + 6). The intervention group underwent simulated direct true lumen cannulation by exsanguination and circulatory arrest for 5 min at 35 degrees C before cardiopulmonary bypass (CPB). Both groups underwent CPB cooling to 25 degrees C followed by a 25-min arrest period and subsequent warming to 36 degrees C. Neuron-specific enolase levels were measured at 6 time-points from blood samples. Near-infrared spectroscopy was used to determine brain oxygenation. The neurological recovery was evaluated daily during a 7-day follow-up, and the brain was harvested for a histopathological analysis after euthanization.RESULTS: All pigs recovered their normal neurological behaviour. The neurobehavioural total score on postoperative day 2 reached borderline statistical significance, thus favouring the intervention group [(9 (8.75-9) vs 6.5 (5.5-9), P = 0.06]. Near-infrared spectroscopy values and neuron-specific enolase levels slightly favoured the control group during the cooling period, but the difference was not clinically significant. The histopathological analysis showed no difference between the groups.CONCLUSIONS: A 5-min period of normothermic global ischaemia before CPB does not impair the neurological outcome following hypothermic circulatory arrest in a surviving porcine model.
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