Transatrial left ventricular cannulation for arterial return in CABG with severe aortic calcification

Introduction: The best management for patients requiring coronary artery bypass surgery (CABG) with severe calcification of the ascending aorta remains a topic of debate. We describe our new transatrial cannulation technique of the left ventricle for arterial return in on-pump CABG procedure. Aims: A seventy years old male was admitted with a dissected right coronary artery (RCA) in right cardiac output failure for emergency CABG. Due to severe aortic calcification we decided to use our new technique for arterial return in acute type A aortic dissection. After a median sternotomy and longitudinal pericardiotomy, the right atrium was cannulated with a common 2-stage venous cannula. For arterial return, an incision was made close to the interatrial groove into the right upper pulmonary vein. Using this access, the arterial cannula was introduced into the left atrium, past the mitral valve and into the left ventricle under transesophageal echocardiographic guidance. Cardio-pulmonary-bypass (CPB) was established with satisfying peripheral perfusion. A sequential vein graft to the RCA was applied and proximal anastomosis was performed in hypothermic cardiopulmonary arrest. No focal neurological disorders occurred. Discussion: We here describe transatrial cannulation of the left ventricle as an alternative cannulation site for arterial return in severe aortic calcification in CABG. Transatrial cannulation proved to be a fast and effective way for establishing CBP. Thus, we suggest to re-evaluate the use of this technique for arterial cannulation in severe aortic calcification.