A New Method of Veno-Venous Bypass during Human Orthotopic Liver Transplantation

Scherer, R.; Giebler, R.; Erhard, J; Länge, R.; Günnicker, M.; Schmutzler, M.; Paar, D.; Wj, Kox

doi:10.1097/00132586-199412000-00069

Cited by 7 publications

(15 citation statements)

References 1 publication

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“…However, it has been shown that even with a heat exchanger incorporated into the system and normothermia there was no reduction in blood transfusion requirement or haemodynamic instability after reperfusion 7 . Other modifications of the venovenous bypass such as puncturing technique might eliminate the inconvenience of direct cutdown of femoral and subclavian veins 24 , but could not avoid the risk of air embolism, major bleeding and activation of the systemic inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Right lobe living donor liver transplantation with or without venovenous bypass

Fan

Yong

et al. 2003

British Journal of Surgery

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Background: Venovenous bypass was considered necessary to maintain haemodynamic stability and avoid splanchnic and retroperitoneal congestion during the anhepatic phase of liver transplantation. It was essential for right lobe living donor liver transplantation (LDLT) in which the inferior vena cava needed to be cross-clamped to construct wide and short hepatic vein anastomoses. However, many complications related to venovenous bypass have been reported. This study aimed to determine whether venovenous bypass was necessary for right lobe LDLT. Results: Compared with patients undergoing operation without venovenous bypass, patients who had venovenous bypass required significantly more blood, fresh frozen plasma and platelet infusion, and had a lower body temperature; their postoperative hepatic and renal function in the first week was worse than that in patients who did not have a bypass. The time to tracheal extubation was longer and the incidence of reintubation for ventilatory support was higher with venovenous bypass. Six of the 29 patients with venovenous bypass died in hospital, compared with two of the 43 patients without a bypass (P = 0·05). By multivariate analysis, the lowest body temperature during the transplant operation was the most significant factor that determined hospital death. Conclusion:Venovenous bypass is not necessary and is probably harmful to patients undergoing right lobe LDLT, and should therefore be avoided.

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Section: Discussionmentioning

confidence: 99%

Right lobe living donor liver transplantation with or without venovenous bypass

Fan

Yong

et al. 2003

British Journal of Surgery

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“…Percutaneous cannulation for bypass offers advantages in terms of surgical time and better flow rates during VVBP and has been reported to be a safe technique. 2,3 Central venous cannulation in general is a safe procedure, and complications of the technique are rarely life threatening. 4 However, deaths occur as a direct result of this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…None of the previously published series of percutaneous cannulation reported major complications, although they report on smaller series. [1][2][3][7][8][9][10] However, a study that reviewed the safety of percutaneous insertion of large-bore cannulae for extracorporeal life support in 94 patients reported 1 death that was the direct result of perforation of the SCV by the cannula. 11 NOTE.…”

Section: Discussionmentioning

confidence: 99%

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Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

et al. 2001

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The aim of this study is to establish the incidence of serious morbidity and mortality associated with the placement of large-bore (18 to 20 F) percutaneous bypass cannulae for venovenous bypass (VVBP) during orthotopic liver transplantation (OLT). This technique has been reported to be rapid, simple, and safe. We reviewed the case notes of 312 patients who underwent OLT in our center using this technique. We describe 4 cases of serious morbidity (incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to percutaneous placement of the bypass cannula. We conclude that percutaneous cannula placement for VVBP during OLT has the potential for lifethreatening complications, and this must be considered when electing to use this technique. When percutaneous cannulae are to be used, we recommend the use of the right internal jugular vein for return cannulation and the use of ultrasound guidance, particularly in those patients in whom cannulation is predictably difficult. S urgical approaches to adult orthotopic liver transplantation (OLT) vary among institutes and individual surgeons around the world. Approaches to maintain venous return if the inferior vena cava is clamped and divided during the conventional surgical technique vary among institutes. Some centers perform venovenous bypass (VVBP) only in high-risk patients, whereas others use VVBP whenever the conventional surgical technique is used. Methods of cannulae placement for VVBP vary among institutes, but percutaneous placement is common and has been reported to be rapid, simple, and safe. [1][2][3] We report the serious morbidity and mortality associated with a series of 312 OLTs performed using VVBP with percutaneous placement of large-bore (18 to 20 F) bypass cannulae over 8 years. MethodsIn this institute, percutaneous catheters for VVBP have been used with increasing frequency since the early 1990s. It is now our practice in those patients undergoing OLT with the use of VVBP to insert two 18 F, polyurethane, 15-cm long, wirereinforced, thin-walled cannulae (Fem-Flex II femoral arterial cannula with internal dilator; Research Medical Inc, Midvale, UT) percutaneously after induction of anesthesia. One cannula is inserted into either the internal jugular (IJV) or subclavian vein (SCV) and the other into a femoral vein using the Seldinger technique and serial dilation. The cannulae are flushed with heparin, 1 IU/mL (maximum, 50 mL), and clamped pending connection to the bypass circuit. In the operating room after mobilization of the portal vein, all cannulae are connected in circuit to the centrifugal pump (Medtronics Inc, Minneapolis, MN).We reviewed the case notes of 312 patients for whom this method of cannulation was used to establish the safety of this technique.

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“…Recently, the percutaneous placement of the femoral cannulae with an axillary vein cut-down' and the percutaneous place- Copyright o 7 996 by the American Association for the Study of Liver Diseases ment of both cannulae have been described. [8][9][10] In 1993, prior to the publication of these reports, we began placing both the femoral vein drainage catheter and a left subclavian vein return catheter using a percutaneous double Seldinger technique. In this report we review our experience with both the cut-down ("open") and percutaneous methods of bypass cannulation.…”

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confidence: 99%

A percutaneous technique for venovenous bypass in orthotopic cadaver liver transplantation and comparison with the open technique

et al. 1996

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Venovenous bypass minimizes the hemodynamic alterations during the anhepatic phase of liver transplantation. A new technique for the percutaneous placement of the bypass cannulae is described and compared to the cut‐down (“open”) technique. The records of 81 patients who underwent 94 liver transplants between August 1991 and April 1994 were reviewed for indications for transplant, United Network for Organ Sharing status, mean age, body surface area, bypass technique and time, flow rates, cardiac output, mean arterial pressure and central venous pressure during bypass, the development of deep venous thrombophlebitis, and lymphoceles. Femoral flow rates were higher in the open group (2054 ± 74 mL/min), compared with the percutaneous group (1726 ± 74 mL/min) (p = 0.003). Total flow rates in the open (2238 ± 58 mL/min) and percutaneous (2197 ± 67 mL/min) groups were not different. Maximum cardiac outputs (L/min) were higher in the open (10.1 ± 0.6) versus percutaneous group (7.0 ± 0.5) (p < 0.0002). Similarly, minimum cardiac outputs (L/min) were higher in the open (8.9 ± 0.7) versus percutaneous group (5.8 ± 0.5) (p = 0.003). Other hemodynamic parameters (mean arterial pressure, central venous pressure) were not different between groups. Venous thrombosis occurred in 1/50 (2.0%) and 4/34 (11.8%) patients in the open and percutaneous groups, respectively (p = 0.153). Nineteen lymphoceles occurred in 102 (18.6%) at‐risk sites in the open group, whereas no lymphoceles occurred in 66 at‐risk sites in the percutaneous group (p < 0.001). Groin lymphoceles occurred in 7/50 (14%) and 0/34 at‐risk sites in the open and percutaneous groups, respectively (p = 0.039). Axillary lymphoceles occurred in 12/52 (23.1%) and 0/32 at‐risk sites in the open and percutaneous groups, respectively (p = 0.0031). Operative repair of a lymphocele was required in 11/16 (69%) patients. The percutaneous placement of catheters for venovenous bypass has the advantage of comparable flow rates with satisfactory hemodynamics without the lymphatic complications of the cut‐down technique. Copyright © 1996 by the American Association for the Study of Liver Diseases.

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A New Method of Veno-Venous Bypass during Human Orthotopic Liver Transplantation

Cited by 7 publications

References 1 publication

Right lobe living donor liver transplantation with or without venovenous bypass

Right lobe living donor liver transplantation with or without venovenous bypass

Morbidity and mortality associated with large-bore percutaneous venovenous bypass cannulation for 312 orthotopic liver transplantations

A percutaneous technique for venovenous bypass in orthotopic cadaver liver transplantation and comparison with the open technique

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