MIC-CAP - Our solution, our idea

Our solution, our idea

The Minimally Invasive Cannula for Central Aortic Perfusion (MIC-CAP)

Our design is aimed to address the limitations of current arterial cannulae (e.g. differential hypoxemia) but remaining in a minimally invasive setting.

Main characteristics:

Insertion through the femoral artery (standard Seldinger’s technique);
The distal extremity is located at the origin of supra-aortic vessels, provided with special perforations and curved so to respect the curvature of aortic arch.
Outside max diameter of 16-18 Fr in the intravascular tract: removal does not require surgery (see references below), thanks to the thin caliber and the use of standard vascular closure devices;
It is flexible, to allow the percutaneous overcoming of the iliac artery, but can maintain the round shape of the lumen;
Radiopaque markers to facilitate the fluoroscopy placement if necessary (e.g.: excessive tortuosity of femoral-iliac axis).

References:

Chandel A, et al. JTCVS Tech. 2021 Aug 26;10:322-330.
Scherer C, et al. J Interv Cardiol. 2022 Mar 18;2022:9915247.
Roberts SH. et al. JTCVS Open 2024;18:80-6.

External validation of the concept

Perfusion. 2023 Sep;38(6):1222-1229. doi: 10.1177/02676591221099809. Epub 2022 May 12.

Computational fluid dynamics analysis of endoluminal aortic perfusion

Daniel Malinowski 1, Yvan Fournier 2, Andreas Horbach 1, Michael Frick 3, Mirko Magliani 4, Sebastian Kalverkamp 4, Martin Hildinger 4, Jan Spillner 4, Mehdi Behbahani 1, Flutura Hima 4

PMID: 35549763; PMCID: PMC10466979; DOI: 10.1177/02676591221099809

Introduction: In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor upper body perfusion due to watershed. With the advent of new long flexible cannulas an advancement of the tip up to the ascending aorta has become feasible. To investigate the impact of such long endoluminal cannulas on upper body perfusion, a Computational Fluid Dynamics (CFD) study was performed considering different support levels and three cannula positions.

Methods: An idealized literature-based- and a real patient proximal aortic geometry including an endoluminal cannula were constructed. The blood flow was considered continuous. Oxygen saturation was set to 80% for the blood coming from the heart and to 100% for the blood leaving the cannula. 50% and 90% venoarterial support levels from the total blood flow rate of 6 l/min were investigated for three different positions of the cannula in the aortic arch.

Results: For both geometries, the placement of the cannula in the ascending aorta led to a superior oxygenation of all aortic blood vessels except for the left coronary artery. Cannula placements at the aortic arch and descending aorta could support supra-aortic arteries, but not the coronary arteries. All positions were able to support all branches with saturated blood at 90% flow volume.

Conclusions: In accordance with clinical observations CFD analysis reveals, that retrograde advancement of a long endoluminal cannula can considerably improve the oxygenation of the upper body and lead to oxygen saturation distributions similar to those of a central cannulation.

Keywords: aortic perfusion; computational fluid dynamics analysis; endoluminal; extracorporeal membrane oxygenation; simulation; watershed.

To sum up: Why the cannula makes the difference? "Power is nothing without control"

An old but always valid concept has been perfectly summed up by the well-known tire brand "Pirelli". Certainly, engines (and similarly, cardiac pumps) are a fundamental component for high performance. The final result, however, also depends on other equally important components, such as tires in car racing or cannulas in cardiac replacement. The best ECMO/ECLS pump or oxygenator cannot have a good performance if the arterial cannula does not deliver properly the oxygenated blood.

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