Extracorporeal Circulation without External Clamping and Cannulation of the Aorta: Transventricular Placement of a New Multifunctional Aortic Cannula


  • Albertus M. Scheule
  • Wolfram Beierlein
  • Andreas Straub
  • Gerhard Ziemer




Background: Stroke is a devastating outcome of coronary artery bypass grafting (CABG). An atherosclerotic ascending aorta is a major risk factor for plaque detachment during cannulation and external clamping in patients undergoing CABG while on extracorporeal circulation (ECC). To avoid external cannulation and clamping we developed and tested a new multifunctional cannula in a pig model.

Methods: The cannula has a double-balloon endoclamping function and is placed via the apex of the left ventricle through the aortic valve in the ascending aorta. It has 2 integrated lines for cardioplegic solution and for venting the left ventricle. In this animal model, a single balloon cannula was used because of the short ascending aorta in pigs.

Results: The cannula was placed smoothly and reproducibly with a guide-wire technique. The cardioplegic solution was administered via aortic root perfusion. Weaning from ECC was uneventful, and macroscopic examination did not reveal any damage to the aortic valve.

Conclusions: This cannula could be used in patients with a severe atherosclerotic ascending aorta. The risk of plaque detachment and stroke during ECC might be reduced.


Barbut D, Hinton RB, Szatrowski TP, et al. 1994. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 25(12):2398-402.nBarbut D, Lo YW, Gold JP, et al. 1997. Impact of embolization during coronary artery bypass grafting on outcome and length of stay. Ann Thorac Surg 63(4):998-1002.nBarbut D, Lo YW, Hartman GS, et al. 1997. Aortic atheroma is related to outcome but not numbers of emboli during coronary bypass. Ann Thorac Surg 64(2):454-9.nDavila-Roman VG, Barzilai B, Wareing TH, Murphy SF, Kouchoukos NT. 1991. Intraoperative ultrasonographic evaluation of the ascending aorta in 100 consecutive patients undergoing cardiac surgery. Circulation 4(5 suppl):III47-53.nInstitute of Laboratory Animal Resources Commission on Life Sciences ILAR). 1985. Guide for the Care and Use of Laboratory Animals. NIH Publication No. 86-23. Bethesda, Md: National Institutes of Health.nKhan NE, De Souza A, Mister R, et al. 2004. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med 350(1):21-8.nMack MJ, Pfister A, Bachand D, et al. 2004. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg 127(1):167-73.nAscione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. 1999. Economic outcome of off-pump coronary artery bypass urgery: a prospective randomized study. Ann Thorac Surg 68(6):2237-42.nPuskas JD, Wright CE, Ronson RS, Brown WM III, Gott JP, Guyton RA. 1998. Off-pump multivessel coronary bypass via sternotomy is safe and effective. Ann Thorac Surg 66(3):1068-72.n



How to Cite

Scheule, A. M., Beierlein, W., Straub, A., & Ziemer, G. (2005). Extracorporeal Circulation without External Clamping and Cannulation of the Aorta: Transventricular Placement of a New Multifunctional Aortic Cannula. The Heart Surgery Forum, 7(6), E569-E570. https://doi.org/10.1532/HSF98.20041105