Interact CardioVasc Thorac Surg 2009;8:250-251. doi:10.1510/icvts.2008.178962
© 2009 European Association of Cardio-Thoracic Surgery
Negative results - Cardiopulmonary bypass |
Disconnection of the tip of the aortic cannula during cardiopulmonary bypass
Rana Sandip Singh,
Harkant Singh*,
Vikas Sharma and
Sachin Mahajan
Department of CTVS, 101-G, MDH, PGIMER, Chandigarh-160012, India
Received 9 March 2008;
received in revised form 21 October 2008;
accepted 23 October 2008
*Corresponding author. Tel.: +919815075294.
E-mail address: baryah{at}gmail.com (H. Singh).
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Abstract
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Objectives: We wish to share a unique occurrence of disconnection of the aortic cannula tip from the rest of the cannula while still on bypass. Methods: This complication was encountered while conducting a coronary artery bypass surgery. Results: We managed to control the situation and resuscitate the patient. No major after-effect was observed and the patient made an uneventful recovery. Conclusions: Such a complication should be kept in mind and the disposables used in every surgery should be checked before using them.
Key Words: Cardiopulmonary bypass; Aortic cannula
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1. Introduction
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Aorta has to be cannulated to establish cardiopulmonary bypass. The procedure of aortic cannulation is not without risks. Complications do occur though they are rare. These include tear in the aortic wall, dissection of the aortic wall etc. We encountered a complication which we had never dreamt of. We wish to share the event.
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2. The case
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While carrying out a coronary artery bypass on CPB, blood was continuously collecting in the pericardial cavity. After the anastomoses were complete, we looked for the source of blood but were unable to find one, even after repeatedly checking the usual sources (the cannulation sites, the anastomosis etc). Finally, we weaned the patient off bypass, took out the venous cannula and were planning to take out the arterial cannula (Fig. 1). While checking the arterial cannula for any leak around it, the cannula suddenly gave away and there was a tremendous gush of blood from the cannulation site. We thought that the tip of the cannula had got broken and perhaps embolised in the aorta. While pinching the aorta at the site of cannulation to control bleeding, something hard came between the fingers and the bleeding would not stop. Something appeared to be stuck at the site of cannulation. It appeared that the tip of the arterial cannula was still fixed in its place where we had inserted it. When the pericardial cavity was emptied by sucking the blood out, it was confirmed that the entire tip of the cannula along with its flanges had got separated from the cannula (Fig. 2) and had remained fixed embedded in the aorta due to the snuggers we had tightened. The bleeding was ultimately brought under control with a finger occluding the cannula tip; snuggers were loosened and the cannula tip extracted using a haemostat to hold it. Meanwhile a lot of blood was lost. We eventually managed to resuscitate the patient and the patient made an uneventful recovery after that (Fig. 3).
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3. Discussion
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We have not come across any such complication in the past in our institute. In the English literature we came across only one report where the metallic tip of the aortic cannula had got disconnected and embolysed into the aorta [1].
Complications associated with aortic cannulation for bypass although rare are well recognised. These include rupture, dissection and pseudoaneurysm formation [2]. Another even rarer complication reported is the embolism of the adjustable ‘position stop’ of the aortic cannulae that come with them [3].
The cannula that we had used was a brand new one. To our mind the reason of disconnection of the cannula could be one or a combination of the following: - Manufacturing defect: The cannula which we use is manufactured in two parts. The body of the cannula, which is wire re-inforced and flexible and the tip which is hard and non-flexible. The two are joined with each other. How they are joined is known to the manufacturer only. If the bond between the body and the tip is not secure enough, it can lead to the complication we faced.
- We tie the cannula with the snugger used to secure it with a heavy silk thread. If the thread is tied too close to the junction of the cannula with the tip, there might be some pinching of the cannula. Since the tip is fitted over the cannula, such pinching might enable the tip to slide off the cannula. Again this slipping of the cannula will be easier if there is a loose connection between the two.
- Temperature changes: The patient is cooled and then rewarmed. This changing temperature might affect the different materials of the cannula and the tip differently, favouring disconnection. But if this was the cause, the event should happen more often.
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4. Conclusion
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Such possibilities must be kept in mind. Since the surgeon cannot have control over the manufacturing process of the disposables, we suggest all the cannulae and preferably all the disposables to be thoroughly checked before use.
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References
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- Scheld HH, Görlach G. Disconnection of the metallic tip of an aortic cannula during cardiopulmonary bypass. Thorac Cardiovasc Surg 1985;33:196–197.[CrossRef][Medline]
- Hayward RH, Korompai FL, Knight WL. Complications of aortic cannulation. Ann Thorac Surg 1984;37:440.[Medline]
- John L. How to prevent foreign body embolism with adjustable ‘position stop' aortic cannulae. Interact Cardiovasc Thorac Surg 2005;4:135–136; Epub 2005 Feb 15.[Abstract/Free Full Text]
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Abstract
1. Introduction
