Venous first double TA-NRP in extended warm-ischemia DCD

Perfusfind S.L.
Dr. Zeraatian, Video Cardiac Surgery Jan 1, 1970 0
 
 
In Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Donation after Circulatory Death (DCD), initiating central cannulation with a venous-first approach serves as a critical step to decompress an acutely distended heart, optimize hemodynamics, and protect both thoracic and abdominal organ quality. Following formal death declaration, a rapid median sternotomy is performed, the pericardium is opened, and the arch vessels are immediately clamped and transected to prevent cerebral reperfusion. Placing a large-bore venous cannula into the right atrium (or cavo-atrial junction) before arterial cannulation immediately evacuates stagnant venous blood, alleviating right ventricular over-stretch caused by post-asystolic warm ischemia and cardiac arrest. This prompt venous drainage not only prevents irreversible right-sided myocardial injury and distension-induced ischemia, but it also rapidly captures systemic venous blood to prime the extracorporeal membrane oxygenation (ECMO) circuit. Once venous decompression and circuit priming are secured, arterial cannulation of the ascending aorta or innominate artery is completed, allowing the initiation of full normothermic oxygenated perfusion. By prioritizing early venous venting, the recovery team minimizes systemic venous backpressure, protects the liver and kidneys from congestive ischemic injury, and creates ideal conditions for rapid myocardial recovery during the subsequent TA-NRP assessment phase.
 

Dr.Sam Zeraatian Nejad Davani, Cardiovascular and Thoracic Surgeon, Transplant and Thoracic Organs Recovery Surgeon. Director of Georgia Atlanta Procure on Demand Thoracic Organs Transplant and Procurement Surgery.   

S.Zeraatiannejaddavani@procureodx.com      

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