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

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. 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. 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. 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.
选择性主动脉弓灌注:首次人体尸体观察研究
选择性主动脉弓灌注(SAAP)是一种新颖的血管内技术,它将胸主动脉闭塞与大脑和心脏的体外灌注结合在一起。SAAP 可用于失血性休克和冠状动脉缺血导致的心脏骤停。尽管动物实验结果令人鼓舞,但目前还没有关于 SAAP 在人体中应用的数据。这项研究的主要目的是评估选择性主动脉弓灌注在人体中的可行性。研究的次要目的是评估通过 SAAP 导管直接进入冠状动脉的可行性,将其作为抢救性经皮冠状动脉介入治疗的潜在管道。利用灌注过的人体尸体,在透视引导下通过标准股动脉经皮入路装置将 SAAP 导管原型插入降主动脉。给导管球囊充气,并用不透射线的造影剂灌注主动脉弓。通过 SAAP 导管插入冠状动脉。手术共进行了四次。在前两次试验中,SAAP 导管快速顺利地通过预定的降主动脉着陆区,并通过该装置成功地进行了主动脉弓灌注。SAAP 导管球囊在第三次试验中失效。在第四次试验中,使用 5Fr 冠状动脉引导导管通过 SAAP 导管中央管腔对左冠状动脉系统进行了插管。通过使用灌注尸体模型,我们首次证明了 SAAP 导管可以轻松安全地插入,并且可以使用传统的血管内技术实现 SAAP。SAAP 导管可成功进入主动脉近端,并允许冠状动脉和脑循环逆行灌注。
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