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.

Effect of the lateral tilt position on femoral vein cross-sectional area in anesthetized adults

“…In these emergencies, the FV may be cannulated temporarily to administer large fluid volumes or drugs. In addition, FV catheterization can be used to measure the pressure of the FV during liver transplantation anesthesia or when extra-corporeal membrane oxygenation is required [14][15][16][17]. Recently, ultrasound has been widely used and FV catheterization can be performed with direct confirmation.…”

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.…”

Levertransplantasjon i Norge gjennom 25 år

“…Den operative teknikken er videreutviklet. I 1993 ble det innført et ekstrakorporalt venovenøst bypasspumpesystem (VVBP) (33), som sannsynligvis er en viktig faktor for at resultatene er blitt bedre etter at dette ble innført (fig 3a, periode 1995-2003). Fra 2001 innførte man en ny kirurgisk teknikk med bevaring av vena cava og med konstruksjon av en temporaer portokaval shunt.…”