Double venous drainage through the superior vena cava in minimally invasive aortic valve replacement: a retrospective study

Abstract

AimTo compare the outcomes of patients who underwent upper mini-sternotomy or right mini-thoracotomy and those who underwent full sternotomy and to report a technical improvement in venous drainage by means of double venous cannulation of the superior vena cava (SVC) in mini surgical procedures.MethodsWe retrospectively analyzed the outcome of 217 patients who underwent aortic valve replacement through upper mini-sternotomy or right mini-thoracotomy at the Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Slovenia from 1996 till 2010. Cannulation of SVC and right atrial appendage was performed in 142/217 (65%) patients, while in the remaining 75 (35%) patients, double cannulation of SVC was used for venous drainage. The results of patients who underwent mini approaches were compared to 236 patients who underwent full sternotomy for the same purpose from 2009 to 2010 at the same center.ResultsWe found a shorter mean length of intensive care unit stay, less volume chest-tube drainage, shorter crossclamp and cardio pulmonary bypass times, and less postoperative permanent pacemaker implantations in the minimally invasive group patients than in full sternotomy group patients. Using double cannulation of the SVC for venous drainage made venous cannulation in mini approaches easier and eliminated the need for obtaining femoral venous access.ConclusionOur study confirmed that even though technically challenging, upper mini-sternotomy and right mini-thoracotomy approaches for aortic valve replacement have potential advantages over conventional median sternotomy. They were proved to be safe, efficacious, and can significantly reduce surgical trauma and are therefore particularly valuable in some higher risk, obese, diabetic and elderly patients. Using double cannulation of SVC for venous drainage made venous cannulation easier and eliminated the need for obtaining femoral venous access.

Mini‐sternotomy vs right anterior thoracotomy for aortic valve replacement

“…The incidence of PPM insertion was not different between the two groups although meta-analysis approached significance, finding a borderline lower incidence of PPM insertion in MS compared to RAT (OR: 0.54, 95% CI: 0.26-1.12; P = .097) ( Figure 4B). The incidence of SSI was reported in six studies, [21][22][23][24][25][26] and found to be similar between MS and RAT groups (OR: 0.65, 95% CI: 0.34-1.27; P = .209) ( Figure 4C).…”

“…The rate of conversion to sternotomy was assessed in four studies. 18,[21][22][23] Meta-analysis found it to be significantly lower in the MS group compared to RAT (OR: 0.32, 95% CI: 0.11-0.93; P = .036) (Figure 2A). CPB was shorter for MS compared with RAT (SMD: −0.36, 95% CI: −0.13 to 0.055; P = 0.436), being reported across seven studies ( Figure 2B).…”

“…Reoperation for bleeding was reported for 2645 patients across eight. 16,18,[21][22][23][24][25][26] Sensitivity analysis, removing a study with high levels of bias from surgeon ability and learning curve, 25 Figure 4A). Heterogeneity was significantly high in this analysis (I 2 = 93.4%, P < .001).…”

Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation—Early results in 203 patients

“…Following opening of the pericardium and placement of pericardial stay sutures, our modified cardiopulmonary bypass (CPB) technique with direct aortic cannulation using EOPA® arterial cannula (Medtronic, Inc.) and superior vena cava (SVC) cannulation with optimized 29‐French OptiFlow venous cannula (Sorin Group) was performed (Figure 1). Surgical technique of the right minithoracotomy approach with completely central cannulation differs from the standard procedure in several steps and is previously described by Klokocovnik et al 21 with the use of double venous drainage. Ventricular vent was placed into the right superior pulmonary vein.…”

Superior vena cava cannulation in aortic valve surgery: an alternative strategy for a hemisternotomy approach

“…In addition, our strategy may be a viable alternative when using a right lateral thoracotomy. Recently, an MIS with double venous cannulation of the superior vena cava has been described to favour complete drainage [8]. However, in our experience, the innovative small-sized, 29-Fr Optiflow cannula provides high-flow drainage across the entire cannula inserted into the right atrium without the need for double cannulation and with no increase in central venous pressure.…”