Augmented venous return for minimally invasive open heart surgery with selective caval cannulation

Jochheim, David; Tevaearai, H. T.; Horisberger, Judith; Mueller, Xavier M.; Boone, Yves; Pierrel, N; Seigneul, I.; Segesser, Ludwig K. von

doi:10.1016/s1010-7940(99)00228-6

Cited by 36 publications

(23 citation statements)

References 11 publications

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“…Kinetic or vacuum assisted venous drainage has been proved useful in the setting of minimally invasive surgery [11,12] and conventional re-operations after cardiac surgery [13] by allowing higher arterial re-infusion flows [13] and reduced blood product use [14]. In the present study, we found no significant difference in arterial re-infusion rates between GSD and KAVD.…”

Section: Discussioncontrasting

confidence: 49%

Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Kirsch

Zannis

Ali

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Background: Heart transplantation in patients supported with ventricular assist devices (VADs) entails a high risk of injury at resternotomy. Prior femorofemoral bypass is the preferred approach in these patients, but poor venous drainage may restrict arterial flow rate. Patients and methods: We compared bypass parameters, transfusion requirements and postoperative outcome in 33 consecutive patients (40.4 AE 12.2 years old, 28 men) assisted with the Thoratec W paracorporeal VAD (mean duration, 3.0 AE 2.96 months) undergoing transplantation using either gravity siphon drainage (GSD, n = 16) or kinetic assisted venous drainage (KAVD, n = 17). Results: Cannulation technique, perfusion pressure, temperature and duration were similar between groups. There were no significant differences in arterial re-infusion flow rates (GSD, 3.6 AE 0.7 vs KAVD, 3.8 AE 0.6 l/min, p = 0.5). KAVD patients had a lower mean S v O 2 and a higher desaturation index than GSD patients (69.5 AE 4.6 vs 76.1 AE 5.4 mmHg, p = 0.004; and 0.63 AE 0.23 vs 0.25 AE 0.63, p = 0.0001, respectively). Perioperative requirements in fresh frozen plasma and platelet transfusions were significantly higher in KAVD patients. However, there were no differences in postoperative patient outcome. Conclusion: Perceived benefits on venous return associated with KAVD do not necessarily translate into improved arterial re-infusion flow rates and should be weighed against the hazards of increased venous air aspiration and blood product requirements. #

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Section: Discussioncontrasting

confidence: 49%

Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Kirsch

Zannis

Ali

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…This technique is now well implanted in some centers, and retrospective studies have been conducted to prove its efficiency and safety. 2,3 Different techniques have been invented to increase the blood flow, such as vacuum-assisted system, kinetic-assisted system with the use of a centrifugal pump, and, more recently, self-expanding basket 4 and self-expanding cannulas. 2 To provide a sufficient blood flow without reducing the operative field with two central cannulas, a peripheral cannulation is needed.…”

mentioning

confidence: 99%

Performance Increase in Venous Drainage for Mini-Invasive Heart Surgery: Superiority of Self-Expanding Cannulas

Belkoniene

Abdel-Sayed

Favre

et al. 2014

Innovations�(Phila)

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Objective Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. Methods To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Results Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, −5.4, −15.9, −45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Conclusions Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

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“…Particularly during minimally invasive cardiac surgery, the inherent characteristics of the percutaneous catheter, such as a longer length and smaller internal diameter compared with standard cardiopulmonary bypass cannulae, reduce venous drainage efficiency during bypass surgery [11]. Hence, adequate positioning of SVC cannulae may become a substantially more important issue as use of minimally invasive cardiac surgery increases.…”

Section: Discussionmentioning

confidence: 99%

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

et al. 2017

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BackgroundThe determination of the adequate depth of superior vena cava cannulae during minimally invasive cardiac surgery is important for warranting venous drainage and preventing complications during cardiopulmonary bypass. We investigated whether preoperative cardiac computed tomography might be useful for predicting the optimal depth of superior vena cava cannulae.MethodsThe patients who required superior vena cava cannulation and had cardiac tomographic image among those scheduled to undergo a minimally invasive cardiac surgery were evaluated. The distance between the upper border of the clavicular sternal head and the superior vena cava-right atrium junction was measured on cardiac computed tomography. Equivalence test for the difference between the distance measured on cardiac computed tomography and the distance verified by surgeon’s direct inspection in the surgical field was performed. The range −1 cm to 1 cm was predefined as an equivalence region. In addition, the distances between the upper border of the clavicular sternal head and the carina level on chest radiography were measured to compare the relative position of carina with regard to the superior vena cava-right atrium junction.ResultsA total of 46 patients were evaluated. The distance from the upper border of the clavicular sternal head to the superior vena cava-right atrium junction measured on cardiac computed tomography and the distance verified by surgeon’s inspection was equivalent, with the 95% confidence interval for the mean difference within the equivalence region (0.05–0.52, P < 0.0001). The carina level on chest radiography was found at least 2 cm above the superior vena cava-right atrium junction in all patients.ConclusionsPreoperative cardiac computed tomography might be valuable for predicting the adequate depth of superior vena cava cannulae. Additionally, the carina on chest radiography might indicate a useful landmark for proper position of central venous catheter.Trial registrationThis study has been registered at Clinical Research Information Service on 6 July 2012 (KCT0000477).Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0347-x) contains supplementary material, which is available to authorized users.

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Augmented venous return for minimally invasive open heart surgery with selective caval cannulation

Cited by 36 publications

References 11 publications

Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Performance Increase in Venous Drainage for Mini-Invasive Heart Surgery: Superiority of Self-Expanding Cannulas

Prediction of the optimal depth for superior vena cava cannulae with cardiac computed tomography during minimally invasive cardiac surgery: a prospective observational cohort study

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