Thoraco-Abdominal Aortic Aneurysm (TAAA) or Left-Heart Bypass (LHB) Protocol for Dr. Davies a.k.a. Descending Thoracic Aneurysm LHB O.R. Nurse/Surgeon Cannulation Supplies: 

  • 20Fr thru 24Fr Straight Lighthouse Venous Cannula used in Left Inferior Pulmonary Vein;
  • using 3/8” x 3/8” Straight Connector
  • 20Fr Right-angle Aortic Cannula (Davies) used in Aorta, Distal to Aneurysm;
  • have 20Fr Straight-tip Aortic Cannula available
  • In the event of Femoral Artery cannulation, a 15Fr or 17Fr Arterial Bio-Medicus Cannula and a 3/8” x 3/8” x 3/8” Y Connector should be available for use
  • May also just got femoral and not Y anything…
  • Tourniquets  x2
  • Medusa (have available in room – will use for mesentery perfusion)

   O.R. Anesthesia Supplies: 

  • NIRS Monitoring Strips  x2

   LHB Pump Circuit Build Supplies: 

  • Lung Pack + Pump Pack 
  • Pressure bag – on AngioVac stopcock
  • Used for bumping up venous line
  • Medusa (for mesentery perfusion) – Y into our non-sterile arterial line with 3/8” x 3/8” x 3/8” connector
  • Have table cut sterile medusa’s Y off and then pass back to you to connect to non-sterile Y
  • Prime up with clear and have scrub nurse set medusa off to the feet
  • i.e. same as KWE dissection set up

 -When logging into Viper, use Adult CPB -Under “perfusion strategy” on patient info tab, selected planned AND left heart bypass. -Oxygenator should be used to regulate the patient’s temperature             -Bypass the reservoir as we do in lung transplants Left-Heart Bypass Technique: -Initiate @ 500ml/min -JED will have you come up on flows gradually “1 L/min” -When the cross clamps are placed, JED will want flows near “2 L/min and MAP 60 - 90mmHg” (Flows are very dependent on pressure; Flow and pressure are inversely proportional;   Increase flows to decrease pressure - Decrease flows to increased pressure). -Femoral arterial line is necessary to monitor perfusion pressure distal to the clamped aorta. -Right-radial arterial line is necessary to monitor perfusion pressure proximal to the clamped aorta. -When distal clamp is placed (2nd clamp placed), anticipate your femoral pressure spiking >100 mmHg -- come down on flow preemptively and then adjust accordingly             -If JED sees this high pressure, he will flip his shit…and no one wants that   *Record all clamp times (talk to JED and make notes of it here) Clamp on time Move clamp time? Move clamp time? Clamp off time Then when off LHB, JED will want transfuse patient blood from circuit into patient via; (1) chase circuit with Isolyte, (2) turn RPM’s up to safely pump back, (3) lift up tubing to gravity fill into patient with blood, Both you and Jamey should clamp the line when done! ____________________________________________________________________ Renal Artery O.R. Nurse/Surgeon Cannulation Supplies: 

  • Normal cardioplegia circuit
  • Using a tubing clamp, clamp the CP line off the oxygenator (distal to take off of manifold)
  • Leave red cricket clamp OPEN
  • Load CP like normal in Buckberg configuration
  • 3/16” Male Luer (pass up to table)
  • Double Y adapter (10004D)  x2 (pass up to table)
  • 4mm thru 8mm Vitalcor Straight Ostial Cannulas  x2 available in room
  • 14Fr Retrograde CP Cannula (Davies) (RC2014)  x2 available in room
  • 13Fr - 15Fr Retrograde CP Cannulas (Pereira) (94113T - 94115T)  x2 available in room

 Renal Artery Pump Circuit Build Perfusion Supplies: 

  • Lactated Ringers 1000 ml  x2 (Anesthesia work-room)
  • Solu-Medrol 125 mg  x2 (CRNA or Anesthesiologist)
  • Mannitol 12.5 g  x2

 Renal Artery Pump Circuit Build: -The renal circuit should be primed with Lactated Ringers. Once the circuit is primed and ready to go, add 125mg Solu-Medrol and 12.5G Mannitol per 1 liter of Lactated Ringers (it is in your best interest to have two bags of LR spiked with drugs added to them). Renal Artery Perfusion Technique: 100 - 150mL/min @ 4°C 170 ± 65mmHg Initial dose: 400 - 600mL Subsequent doses 100 - 200mL (remind JED 15 - 20 min) ____________________________________________________________________Distal (Superior Mesenteric Artery) Perfusion Supplies: 

  • 3/8” x 3/8” x 1/4” Y Connector OR 3/8” x 3/8” x 3/8” Y Connector (used to Y the arterial line)
  • Medusa
  • Scrub or JED will cut into arterial line, JED has stated he does not need it Y’d into the circuit every time
  • 14Fr Retrograde CP Cannula (Davies) (RC2014)  x3 available