Mini-Bentall Procedure and Hemiarch Replacement: Cannulation

In this video, the second in a seven-part series, Tristan Yan demonstrates a technique for peripheral venous and central aortic cannulation for the Mini-Bentall and hemiarch procedure.

1. A vacuum-assist device is built in the cardiopulmonary bypass circuit (CPB) to maximize venous drainage.
2. Peripheral venous cannulation is established first, using the Seldinger technique.
3. The femoral vein is punctured and a guide wire is passed up to the superior vena cava. The position of the wire is confirmed with transoesophageal echocardiography (TOE) through a bicaval view. The femoral vein puncture site is then progressively dilated.
4. A 25 Fr Bio-Medicus multi-stage venous cannula (Medtronic Inc., Minneapolis, MN, USA) is introduced. The pointy-tipped insert is not advanced further once it enters the right atrium. Only the venous cannula itself is now advanced forward over the insert, strictly under the TOE guidance. It is essential that the cannula tip be placed in the superior vena cava to ensure satisfactory bicaval venous return.
5. The venous cannula is connected to the CPB circuit. Arterial cannulation is established via the distal ascending aorta.
6. The aorta is carefully cannulated with an elongated one-piece arterial cannula (Medtronic Inc., Minneapolis, MN, USA), which is secured in position and connected to the CPB circuit. Once CPB is established, the heart is off-loaded.
7. Systemic temperature is lowered to 25 degrees. In this case, splitting the arterial line is necessary beforehand in order to provide additional cerebral perfusion.

View all videos in this series here.