LEFT CENTRIFUGAL PUMP CARDIAC ASSIST WITH TRANSSEPTAL PERCUTANEOUS LEFT ATRIAL CANNULA

Left cardiac support postcardiotomy requires a second operation for re moval of the atrial cannula following weaning from assistance. To avoi d the risk of this procedure, we used a transseptal cannula prototype. The cannula was introduced percutaneously through the femoral vein an d advanced into the left atrium guided by the finger of the surgeon. O ptimal positioning of the tip of the cannula was verified by periopera tive transesophageal echocardiography. A long arterial cannula was pos itioned in the descending aorta via the femoral artery and a Carmeda c ircuit with a centrifugal pump was connected to both cannulas. This pr ocedure was used in 3 patients with low cardiac output who underwent e mergency surgery, a 63-year-old patient referred for aortic and mitral valve replacement, a 54-year-old man for aortic valve replacement, an d a 64-year-old patient in the acute phase of myocardial infarction af ter myocardial revascularization. The assistance was used systematical ly at the end of the operation. The assist flow was 1.2-2.6 L/min. The patients were all weaned from support between 18 h and 8 days later. No complications related to the device occurred. Both cannulas were re moved surgically from the femoral vessels without reopening the chest. This new procedure is of interest for 2 reasons: the systematic impla ntation allows for early assistance, and the use of a percutaneous app roach avoids the risk of reopening the chest. More cases are needed to confirm this initial good impression.