Returning reservoir blood to right atrium during extracorporeal circulation for descending aortic surgery

We report our techniques on conducting a closed-circuit femoral-femoral bypass during descending aortic surgery by which collected blood can be easily returned into the right atrium. The main circuit was composed of a centrifugal pump, an artificial membrane lung, and a filter. A reservoir with a roller pump was connected to the main circuit via a filter. Extracorporeal circulation was established by right atrial drainage via the femoral vein and femoral arterial return. On aortic crossclamping, systemic blood pressure was controlled by activating the roller pump in reverse rotation and shifting the body blood into the reservoir temporarily. For a small amount of bleeding after aortotomy, the reservoir blood was returned via the femoral artery by activating the roller pump in normal rotation. When a large amount of bleeding was present making the systemic blood pressure fall, the main circuit was clamped just distal to the centrifugal pump and reservoir blood was directly returned to the right atrium to maintain systemic pressure. Confirming that bleeding was reduced, the clamp distal to the centrifugal pump was gradually released and blood was delivered to both the right atrium and the femoral artery. We believe that our system is a highly beneficial modality.