Selective aortic arch perfusion: a first-in-human observational cadaveric study
Abstract Background 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 promisin...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-12-01
|
| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-023-01148-z |
| _version_ | 1797388160516227072 |
|---|---|
| author | Max Marsden Jon Barratt Helen Donald-Simpson Tracey Wilkinson Jim Manning Paul Rees |
| author_facet | Max Marsden Jon Barratt Helen Donald-Simpson Tracey Wilkinson Jim Manning Paul Rees |
| author_sort | Max Marsden |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-03-08T22:35:46Z |
| format | Article |
| id | doaj.art-d6d5edac572c4af4a4672abb84689c08 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-03-08T22:35:46Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-d6d5edac572c4af4a4672abb84689c082023-12-17T12:28:28ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412023-12-013111610.1186/s13049-023-01148-zSelective aortic arch perfusion: a first-in-human observational cadaveric studyMax Marsden0Jon Barratt1Helen Donald-Simpson2Tracey Wilkinson3Jim Manning4Paul Rees5Blizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of LondonDefence Endovascular Resuscitation Group, Research and Clinical InnovationTayside Innovation MedTech Ecosystem TIME, University of DundeeHuman Anatomy Unit, College of Medical and Dental Sciences, University of BirminghamDepartment of Emergency Medicine, University of North Carolina at Chapel HillBlizard Institute, The Faculty of Medicine and Dentistry, Queen Mary University of LondonAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s13049-023-01148-zResuscitationEndovascularTraumaCardiac arrestSAAP |
| spellingShingle | Max Marsden Jon Barratt Helen Donald-Simpson Tracey Wilkinson Jim Manning Paul Rees Selective aortic arch perfusion: a first-in-human observational cadaveric study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Resuscitation Endovascular Trauma Cardiac arrest SAAP |
| title | Selective aortic arch perfusion: a first-in-human observational cadaveric study |
| title_full | Selective aortic arch perfusion: a first-in-human observational cadaveric study |
| title_fullStr | Selective aortic arch perfusion: a first-in-human observational cadaveric study |
| title_full_unstemmed | Selective aortic arch perfusion: a first-in-human observational cadaveric study |
| title_short | Selective aortic arch perfusion: a first-in-human observational cadaveric study |
| title_sort | selective aortic arch perfusion a first in human observational cadaveric study |
| topic | Resuscitation Endovascular Trauma Cardiac arrest SAAP |
| url | https://doi.org/10.1186/s13049-023-01148-z |
| work_keys_str_mv | AT maxmarsden selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy AT jonbarratt selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy AT helendonaldsimpson selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy AT traceywilkinson selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy AT jimmanning selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy AT paulrees selectiveaorticarchperfusionafirstinhumanobservationalcadavericstudy |