Cannulations for cardiopulmonary bypass

Cardiopulmonary bypass (CPB) is established through a venous line and an arterial line. Thus both a venous and an arterial cannulation are mandatory. Additional cannulation sites include for the administration of cardioplegia solution and for venting the cardiac chambers. According to the sites of cannula insertion, CPB can be defined in central or peripheral cannulation. The ascending aorta and the right atrium are considered traditionally the main sites for central cannulation. However, for right-sided intracardiac cases and for access to the interatrial groove for the left atriotomy a bicaval technique (both superior and inferior vena cava) is preferred as venous cannulation site. In operations where the aortic arch is involved, arterial cannulation can be performed through peripheral vessels, transverse aortic arch, brachiocephalic trunk or its branches. Minimally invasive operations require peripheral approach of femoral vessels even combined with jugular vein and/or right axillary artery cannulation. These vessels can be surgically exposed or percutaneously cannulated using the Seldinger technique. Antegrade cardioplegia is administered through the ascending aorta, while retrograde cardioplegia via the venous sinus cannulation through the right atrium. Left chamber venting is performed introducing a suction cannula through the upper right pulmonary vein or the pulmonary trunk. Finally, minimally invasive approaches can benefit from endovascular clamping and endovascular venting placed in a percutaneous fashion.