Selective aortic arch perfusion: a first-in-human observational cadaveric study

Max Marsden, Jon Barratt, Helen Donald-Simpson, Tracey Wilkinson, Jim Manning, Paul Rees

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    Abstract

    BACKGROUND: Selective aortic arch perfusion (SAAP) is a novel endovascular technique that combines thoracic aortic occlusion with extracorporeal perfusion of the brain and heart. SAAP may have a role in both haemorrhagic shock and in cardiac arrest due to coronary ischaemia. Despite promising animal studies, no data is available that describes SAAP in humans. The primary aim of this study was to assess the feasibility of selective aortic arch perfusion in humans. The secondary aim of the study was to assess the feasibility of achieving direct coronary artery access via the SAAP catheter as a potential conduit for salvage percutaneous coronary intervention.

    METHODS: Using perfused human cadavers, a prototype SAAP catheter was inserted into the descending aorta under fluoroscopic guidance via a standard femoral percutaneous access device. The catheter balloon was inflated and the aortic arch perfused with radio-opaque contrast. The coronary arteries were cannulated through the SAAP catheter.

    RESULTS: The procedure was conducted four times. During the first two trials the SAAP catheter was passed rapidly and without incident to the intended descending aortic landing zone and aortic arch perfusion was successfully delivered via the device. The SAAP catheter balloon failed on the third trial. On the fourth trial the left coronary system was cannulated using a 5Fr coronary guiding catheter through the central SAAP catheter lumen.

    CONCLUSIONS: For the first time using a perfused cadaveric model we have demonstrated that a SAAP catheter can be easily and safely inserted and SAAP can be achieved using conventional endovascular techniques. The SAAP catheter allowed successful access to the proximal aorta and permitted retrograde perfusion of the coronary and cerebral circulation.

    Original languageEnglish
    Article number97
    Number of pages6
    JournalScandinavian journal of trauma, resuscitation and emergency medicine
    Volume31
    Issue number1
    DOIs
    Publication statusPublished - 12 Dec 2023

    Keywords

    • Animals
    • Humans
    • Aorta, Thoracic/surgery
    • Heart Arrest
    • Aorta
    • Perfusion/methods
    • Shock, Hemorrhagic
    • Endovascular
    • Cardiac arrest
    • SAAP
    • Trauma
    • Resuscitation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Emergency Medicine

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