Original Article

Pulmonary Artery to Descending Thoracic Aorta Bypass: An Alternative Approach to Vascular Access for Open Heart Surgery

Humana Heart Institute International, Louisville, KY

^* Direct communications to: William J. Gil, B.S., C.C.P., 2390 Bellwood St., Pittsburgh, PA 15237

Abstract

(J. Extra-Corpor. Technol. 19[3] p. 372-375 Fall 1987, 8 ref.) A variety of conditions can increase the mortality and morbidity of a midsternotomy approach for cardiothoracic surgery. Among these complicating conditions are reoperations, sternal infections and past mediastinal radiation therapy. In the face of the inherent risks of midsternotomy in these situations an alternate, left thoracotomy approach, has successfully been employed.

The left thoracotomy approach for cardiopulmonary bypass necessitates a unique cannulation technique. The pulmonary artery is cannulated for venous return to the cardiopulmonary bypass circuit. Systemic blood flow to the patient is via the descending thoracic aorta. The femoral artery may also be used for arterial access.

The physiological principles that allow the pulmonary artery to be used as the venous cannulation site, the cardiothoracic procedures this may avail itself to, and the safety techniques used when this approach is employed will be discussed. Several cases in which this technique was used will also be reviewed.