Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

Abstract

We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique. Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction of a heat exchanger offer significant benefits and that they are safe and reliable.

Heparin coating reduces cell activation and mediator release in an in vitro venovenous bypass model for liver transplantation

“…We recently described a modification of conventional VVBP in OLT [12]. In the present study, we used this VVBP system in an in vitro model.…”

“…Venovenous bypass (VVBP) is used routinely during human orthotopic liver transplantation (OLT) to prevent venous stasis in the lower part of the body and splanchnic venous pooling during the anhepatic phase [7,12,151. Both noncoated and heparin-coated VVBP are in use worldwide, but no comparative studies have been performed in order to evaluate these systems.…”

The significance of heparin-coated veno-venous bypass circuits in liver transplantation

“…The use of VVBP at the Surgical Department at our institution, including percutaneous technique for cannula insertion, a heat exchanger and using the inferior mesenteric vein for splanchnic decompression, has been described in detail elsewhere. 7 Duration of VVBP was 100 (65 -168) min (mean and range). Blood samples were drawn at the following times: 1) at induction of anesthesia, 2) just before the start of VVBP, 3) 5 min after the start of VVBP, 4) just before the termination of VVBP, 5) 5 min after the termination of VVBP, and 6) the first postoperative day.…”

Veno-venous bypass in liver transplantation: heparin-coated perfusion circuits reduce the activation of humoral defense systems in an in vitro model

“…1 Adverse effects related to the anhepatic phase can be ameliorated by the use of an extracorporeal venovenous bypass (VVBP) system where a centrifugal pump shunts blood from the inferior caval and portal veins to the axillary or jugular vein. [2][3][4][5] This technique prevents venous stasis, preserves renal function, decreases peroperative blood loss, minimizes third space fluid losses and allows hepatectomy and subsequent implantation to be performed during hemodynamically stable conditions. 6 Several studies have reported that the use of VVBP in orthotopic liver transplantation (OLT) has resulted in reduced recipient morbidity and mortality.…”

“…An in vitro VVBP perfusion model (Figure 1) was used where all components of the circuit were identical to those used for liver transplantation in humans at our institution. 4 The circuit was primed with 500 ml of Ringer's acetate, and human whole blood (440 ml blood and 60 ml CPD anticoagulant) from a single donor was used in each experiment. The bypass circuit consisted of a custom pack liver set (model CB 4649 with 3/8Љ PVC tubings; Medtronic, MN, USA), including a reservoir, a centrifugal pump (Biomedicus BP-80; Medtronic, MN, USA) maintaining a constant non-pulsatile flow of 2 l/min and a heat exchanger (D 720 Helios-A CP; Dideco, Mirandola, Italy) maintaining a constant temperature of 37.5°C.…”