title: Direct cannulation of the infrahepatic vena cava for emergent cardiopulmonary bypass support.
abstract: Cannulation for cardiopulmonary bypass, although seemingly routine, can pose technical challenges. In patients undergoing repeat sternotomy, for example, peripherally established cardiopulmonary bypass may be necessary to ensure safe entry into the chest; however, establishing bypass in this way can sometimes be complicated by patients' body habitus. We describe a technique for direct cannulation of the infrahepatic abdominal vena cava that was required for emergent cardiopulmonary bypass. The patient was a 62-year-old woman who had presented with severely symptomatic left main coronary stenosis 3 months after elective aortic valve replacement. She had gone into cardiogenic shock as general anesthesia was being induced for repeat sternotomy and myocardial revascularization. Emergent establishment of femorofemoral cardiopulmonary bypass was precluded by difficulties in advancing the femoral venous cannula beyond the pelvic brim. Hence, an emergent celiotomy was performed, and the abdominal vena cava was directly cannulated to establish venous drainage for cardiopulmonary bypass. The rest of the operation was uneventful. Our technique for direct cannulation of the infrahepatic abdominal vena cava may be used in exceptional circumstances. Necessary precautions and potential pitfalls are also presented.
authors.affiliation: Division of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA. gopaldas@bcm.edu
authors.forename: Raja R
authors.initials: RR
authors.lastname: Gopaldas
authors.forename: Kirti P
authors.initials: KP
authors.lastname: Patel
authors.forename: James J
authors.initials: JJ
authors.lastname: Livesay
authors.forename: Denton A
authors.initials: DA
authors.lastname: Cooley
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
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