Percutaneous Venous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique Described Step-by-Step

Alberto Pozzoli; Tiziano Torre; Francesca Toto; Thomas Theologou; Enrico Ferrari; Stefanos Demertzis

doi:10.3389/fsurg.2022.828772

Percutaneous Venous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique Described Step-by-Step

Front Surg. 2022 Mar 22:9:828772. doi: 10.3389/fsurg.2022.828772. eCollection 2022.

Authors

Alberto Pozzoli¹, Tiziano Torre¹, Francesca Toto¹, Thomas Theologou^{1

2}, Enrico Ferrari^{1

2}, Stefanos Demertzis^{1

2}

Affiliations

¹ Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland.
² Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.

Abstract

The current cardiac surgical landscape, with the expansion of minimally invasive operations, ECMO, and some interventional therapies, requires a thorough knowledge of peripheral cannulation techniques. In particular, venous cannulation may appear trivial and complication-free, but this does not reflect the reality. A venous cannulation which is not perfectly performed can lead to serious life-threatening complications in several steps. The technique we describe step by step is the current gold standard in terms of safety and efficacy: from the use of ultrasound for ultrasound-guided puncture to safe advancement of super stiff guidewires by means of a sentinel catheter, and concluding with smooth insertion of the venous cannula over the stiff guidewire up to the SVC. Moreover, a list of bailout maneuvers to solve complications is presented along with a report of institutional clinical experience since the adoption of this technique.

Keywords: echo-guided venous puncture; minimally invasive cardiac surgery; transesophageal echocardiography; venous cannulation; wire skills.