Evaluation of Different Cannulation Strategies for Aortic Arch Surgery Using a Cardiovascular Numerical Simulator

Figures

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  Figure 1. Schematic representation of the four cannulation strategies: right atrial to ascending aorta and bilateral common carotid artery return (top left); right atrial to femoral artery and bilateral common carotid artery return (top right); femoral vein and SVC to femoral artery and bilateral common carotid artery return (bottom left); and femoral vein to femoral artery and bilateral common carotid artery return (bottom right).

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  Figure 2. (a) Schematic representation of the cardiovascular system implemented in CARDIOSIM© software platform. (b) Electric analogue of the ascending and descending aorta, aortic arch, thoracic and abdominal sections and superior vena cava. (c) Electric analogue of the upper and lower limbs and the head. The six switches allow the activation of one of the four cannulation strategies. (d) Electric analogue of abdominal section (II), splanchnic, renal, hepatic, inferior and abdominal vena cava sections.

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  Figure 3. Top left panel (bottom left panel) shows the left (right) ventricular pressure–volume loops in baseline conditions (dashed black line) and for RA→FA&CC cannulation with centrifugal speed pump set to 2000 rpm (dashed lilac line), 2500 rpm (green line), 3000 rpm (continuous black line), 3500 rpm (red line), 4000 rpm (dashed brown line) and 4500 rpm (lilac line). The ventricular loops obtained using CARDIOSIM© were stored in excel files and subsequently plotted. The (right panel) shows the RA→FA&CC cannulation in which the centrifugal pump draws blood from the right ventricle and ejects it in the femoral artery and common carotid artery bilaterally.

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  Figure 4. The top (middle) panel shows the left ventricular (atrial) pressure–volume loop obtained in baseline conditions and following the four different methods of cannulation when the centrifugal pump speed was set to 2000 rpm. The (bottom panel) shows the right ventricular pressure–volume loops. The dashed black loop is obtained in baseline conditions. The red, green, light blue and lilac loops are obtained following RA→AA&CC, RA→FA&CC, FV→FA&CC and FV&SVC→FA&CC connection, respectively.

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  Figure 5. AoP (top-left panel) and PAP (bottom-left panel) waveforms obtained in baseline conditions and with FV&SVC→FA&CC cannulation when the pump rotational speed was set to 2000, 3500 and 4500 rpm. The (right panel) shows the FV&SVC→FA&CC cannulation in which the centrifugal pump has two input cannulae (from superior vena cava and femoral vein) and two output cannulae (to femoral and common carotid arteries).

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  Figure 6. Right ventricular pressure–volume loops (top left panel) and instantaneous PAP waveforms (bottom left panel) obtained in baseline conditions (black dashed line) and with FV→FA&CC cannulation when the pump rotational speed was set to 2000 (red line), 2500 (blue line), 3000 (green line) and 3500 (light blue line) rpm. The ventricular loops and the instantaneous waveforms obtained using CARDIOSIM© were stored in excel files and subsequently plotted. In FV→FA&CC cannulation (right panel), the centrifugal pump draws blood from the femoral vein and ejects it into the femoral artery and common carotid artery bilaterally.

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  Figure 7. Left atrial pressure–volume loops (top-left panel) and instantaneous AoP waveforms (bottom-left panel) obtained in baseline conditions (black dashed line) and with RA→AA&CC cannulation when the pump rotational speed was set to 2000 (red line), 2500 (blue line) and 3000 (lilac line) rpm. The ventricular loops and the instantaneous waveforms obtained using CARDIOSIM© were stored in excel files and subsequently plotted. In RA→AA&CC cannulation (right panel) the centrifugal pump draws blood from the right atrium and ejects it into the ascending aorta and common carotid artery bilaterally.

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  Figure 8. Relative changes calculated in comparison to baseline conditions for the four different methods of cannulation with pump rotational speed set to 2500 rpm. The top (bottom)-left panel shows the relative changes in the aortic pressure AoP (left atrial pressure). The top (bottom)-right panel shows the relative changes in the cardiac output CO (right atrial pressure).

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  Figure 9. Relative CO changes calculated in comparison to baseline conditions for the four different cannulation strategies at different pump rotational speed. The top (bottom)-left panel shows the relative changes in CO induced by RA→AA&CC (FV&SVC→FA&CC) cannulation. The top (bottom)-right panel shows the relative changes in cardiac output induced by RA→FA&CC (FV→FA&CC) cannulation.

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  Figure 10. The top-left (right) panel shows the relative changes in left (right) ventricular–arterial coupling EaS/EesLeft (EaP/EesRight) for different cannulations applied with pump rotational speed set to 3500 rpm. The relative changes estimate with respect to baseline conditions of the energetic variable (EW) for the left (right) ventricle is reported in the bottom-left (right) panel.

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  Figure 11. The top-left (right) panel shows the relative changes in left (right) ventricular EW (PVA) observed for three different cannulations with pump rotational speed set to 2000, 2500, 3000, 3500, 4000 and 4500 rpm. The bottom left (right) panel shows the relative changes in right (left) atrial pressure compared to baseline conditions for FV→FA&CC, FV&SVC→FA&CC and RA→AA&CC cannulation configurations with pump rotational speed set to 2000, 2500, 3000 and 3500 rpm.

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  Figure 12. The (top-left panel) shows the relative changes in cerebral blood flow induced by three different cannulation configurations with pump rotational speed set to 3500 rpm. The relative changes in cerebral blood flow, superior vena cava flow and cardiac output for RA→FA&CC cannulation with pump speed set to 2500 rpm are available in the (top-right panel). Relative changes in CO*, cerebral blood flow* and SVC* blood flow were evaluated when a little increase in ascending aorta resistance was considered during the simulation. Kidney flow*, hepatic flow* (bottom-right panel), PAP* and LAP* (bottom-left panel) were evaluated in the same conditions when the pump rotational speed was set to 2500 and 3500 rpm, respectively.