Reply to the Editor

Abstract

We thank Mariani and colleagues for their interest, and for their observations and remarks. Both reports that Mariani and colleagues refer to1Demertzis S. Carrel T. Rapid peripheral arterial cannulation for extracorporeal life support with unimpaired distal perfusion.J Thorac Cardiovasc Surg. 2011; 141: 1080-1081Google Scholar, 2Demertzis S. Carrel T. Transformation of percutaneous venoarterial extracorporeal membrane oxygenation access to a safe peripheral arterial cannulation.J Thorac Cardiovasc Surg. 2013; 146: 1293-1294Google Scholar are technical descriptions of surgical maneuvers conceived to deal with distinct clinical situations; they should not be perceived as clinical studies. Therefore, any comparison between them in terms of complications or outcomes would not be appropriate. In the last report,2Demertzis S. Carrel T. Transformation of percutaneous venoarterial extracorporeal membrane oxygenation access to a safe peripheral arterial cannulation.J Thorac Cardiovasc Surg. 2013; 146: 1293-1294Google Scholar we suggest elective transformation of a percutaneous cannulation to a transprosthetic one as an alternative to a distal perfusion cannula. Generally we agree with Mariani and colleagues: a full percutaneous approach can lower cannulation site complications, especially bleeding, during perfusion. However, in situations where a safe (ie, ultrasound or angiographically controlled) insertion of a distal perfusion cannula is not possible or if the perfusion provided by such is not sufficient, the presented surgical technique can be helpful. We do not agree with the statement that the open technique would bear higher risks for dissection, laceration, thrombosis, embolization, arteriovenous fistula compared with the percutaneous technique. In our experience, the contrary is the case. This is the reason we insist on a safe and controlled punction and insertion for both primary and distal perfusion cannulas. Infection of the prosthesis could theoretically be an issue, however the rather short duration of arteriovenous perfusion and the subsequent removal of the long prosthesis minimize this risk. In any case, the cannulation site is monitored by standardized clinical protocols several times a day. Both techniques described in our technical reports1Demertzis S. Carrel T. Rapid peripheral arterial cannulation for extracorporeal life support with unimpaired distal perfusion.J Thorac Cardiovasc Surg. 2011; 141: 1080-1081Google Scholar, 2Demertzis S. Carrel T. Transformation of percutaneous venoarterial extracorporeal membrane oxygenation access to a safe peripheral arterial cannulation.J Thorac Cardiovasc Surg. 2013; 146: 1293-1294Google Scholar should be perceived as additional elements in the armamentarium of a cardiovascular surgeon. The more alternatives we have, the better we can serve our patients, especially in critical situations. Limb ischemia and femoral arterial cannulation for extracorporeal membrane oxygenation: Does the perfect technique exist?The Journal of Thoracic and Cardiovascular SurgeryVol. 147Issue 5PreviewWe read the very interesting report by Demertzis and Carrel1 presenting a technique for the transformation of percutaneous femoral cannulation to chimney-graft cannulation for arterial access in extracorporeal membrane oxygenation (ECMO) support. They reported a series of 3 patients undergoing venoarterial ECMO who received percutaneous cannulation through femoral vessels and a switch to transprosthetic cannulation within the following 24 hours. After surgical preparation of the common femoral artery, an end-to-side anastomosis between the vascular prosthesis and the arterial vessel was performed proximally to the insertion of the ECMO cannula. Full-Text PDF