68: Application of a Cryopreserved Homograft in Peripheral Extracorporeal Membrane Oxygenation Cannulation

Introduction: This case report describes the application of a peripheral ECMO cannulation technique utilizing a cryopreserved homograft of the abdominal aorta as a vascular conduit. Methods: A 62-year-old male patient was admitted with a diagnosis of coronary artery disease, an aneurysm of the ascending aorta, and permanent atrial fibrillation. The patient underwent David procedurе, radiofrequency ablation for atrial fibrillation. On the second postoperative day, the patient’s condition deteriorated significantly, manifesting as progressive cardiovascular failure, episodes of ventricular tachycardia, and a rise in lactate levels to 20 mmol/L. The decision was made to initiate VA ECMO. Ultrasound examination revealed small diameter and diffuse atherosclerosis of the femoral arteries, precluding femoral arterial cannulation. A resternotomy was performed, with the arterial cannula for ECMO placed directly into the ascending aorta, and the venous cannula inserted into the femoral vein under ultrasound guidance. Given the anticipated need for prolonged mechanical circulatory support and the elevated risk of infectious complications as well as bleeding associated with an open sternum, the decision was made on the second day of ECMO to close the chest and replace cannulation site. The right subclavian artery was cannulated using a cryopreserved homograft of the abdominal aorta as an arterial conduit. On day 27, following recovery of cardiac function, mechanical circulatory support was successfully discontinued. The total duration of ECMO support was 27 days. Results: Cannulation via the homograft conduit effectively minimized bleeding at the arterial cannulation site, despite the high-pressure anastomosis. This was achieved due to the graft’s wall elasticity and the enhanced positional maneuverability of the cannula it provided. Conclusions: The subclavian artery serves as a viable alternative access site when conventional cannulation techniques are contraindicated. This clinical case demonstrates the successful use of a cryopreserved vascular homograft for peripheral ECMO, facilitating long-term support and patient stabilization.