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

Belkoniene, Mhedi; Abdel-Sayed, Saad; Favre, Julien; Segesser, L. von

doi:10.1097/imi.0000000000000083

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…6,7 However, current clinical practice in MICS is to run for venous drainage augmentations of up to 80 mm Hg, [2][3][4]11,12 and under these conditions, it seemed worthwhile to design a smaller virtually wall-less cannula, taking advantage of the higher augmentation used in clinical routine for this setting. Following positive results during in silico and in vitro evaluation of this new thinner 24 F ST design with increased hoop strength, 13,14 the present study was realized for in vivo validation and confirmed the benefit of this approach. There are a number of reasons that can explain the performance increase of the virtually wall-less cannula designs compared to traditional thin-wall percutaneous cannulas including the following:…”

Section: Discussionsupporting

confidence: 59%

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Segesser

Berdajs

Abdel-Sayed

et al. 2016

Innovations�(Phila)

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Objective Inadequate venous drainage during minimally invasive cardiac surgery becomes most evident when the blood trapped in the pulmonary circulation floods the surgical field. The present study was designed to assess the in vivo performance of new, thinner, virtually wall-less, venous cannulas designed for augmented venous drainage in comparison to traditional thin-wall cannulas. Methods Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with percutaneous venous access over the wire, serial dilation up to 18 F and insertion of either traditional 19 F thin wall, wire-wound cannulas, or through the same access channel, new, thinner, virtually wall-less, braided cannulas designed for augmented venous drainage. A standard minimal extracorporeal circuit set with a centrifugal pump and a hollow fiber membrane oxygenator, but no inline reservoir was used. One hundred fifty pairs of pump-flow and required pump inlet pressure values were recorded with calibrated pressure transducers and a flowmeter calibrated by a volumetric tank and timer at increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments). Results Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45 l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM, 5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for 9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, −42.4 ± 26.7 versus −123 ± 51.1 at 2500 RPM, and −126.7 ± 55.3 versus −313 ±116.7 for 3500 RPM. Conclusions At the well-accepted pump inlet pressure of −80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings.

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Section: Discussionsupporting

confidence: 59%

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Segesser

Berdajs

Abdel-Sayed

et al. 2016

Innovations�(Phila)

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“…Interestingly enough, the difference in flow is around 6% for wall-less versus 10% for thin wall, which indicates a more restrictive drainage pattern for the latter and is in line with the previous assessments in vivo. It was previously demonstrated that the virtually wall-less cannulas outperform the available commercial cannulas 8,[15][16][17][18][19] with higher flows despite reduced suction requirements. The latter finding is again confirmed here.…”

Section: Discussionmentioning

confidence: 99%

Effect of blood viscosity on the performance of virtually wall-less venous cannulas

Abdel-Sayed

Berdaj

et al. 2019

Perfusion

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Aim: This study was designed to quantify the influence of blood as test medium compared to water in cannula bench performance assessment. Methods: An in vitro circuit was set-up with silicone tubing between two reservoirs. The test medium was pumped from the lower reservoir by centrifugal pump to the upper reservoir. The test-cannula was inserted in a silicone tube connected between the lower reservoir and the centrifugal pump. Flow rate and pump inlet-pressure were measured for wall-less versus thin-wall cannula using a centrifugal pump in a dynamic bench-test for an afterload of 40-60 mmHg using two media: blood 10 g/dL and 5.6 g/dL and water 0 g/dL. Results: The wall-less cannula showed significantly higher flows rates as compared to the thin-wall cannula (control), with both hemoglobin concentrations and water. Indeed, for a target volume of 200-250 mL of blood (Hg 10 g/dL) in the upper reservoir, the cannula outlet pressure (P) was −14 ± 14 mmHg versus −18 ± 11 mmHg for the wall-less and control respectively; the cannula outlet flow rate (Q) was 3.91 ± 0.41 versus 3.67 ± 0.45 L/min, respectively. At the same target volume but with a Hg of 5.7 g/dL, P was −16 ± 12 mmHg versus −19 ± 12 mmHg and Q was 4 ± 0.1 versus 4 ± 0.4 L/min for the wall-less cannula and control respectively. Likewise, P and Q values with water were −1 mmHg versus −0.67 ± 0.58 mmHg and 4.17 ± 0.45 L/min versus 4.08 ± 0.47 L/min for the wall-less and control respectively. Conclusion: Walls-less cannula showed 5.6% less pump inlet-pressure differences calculated between blood and water, as compared to that of thin-wall cannula (−21 times). Flow differences were 6% and 10% for the walls-less and thin-wall cannula respectively. We conclude that testing the cannula performance with water is a good scenario and can overestimate the flow by a 10%. However, superiority for wall-less is preserved with both water and blood.

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“…3 Consequently, a new cannula ( smart canula ® ; Smartcanula LLC, Lausanne, Switzerland) was developed that can change shape in situ and therefore may improve venous drainage. 1,4 Clinical experience with this virtually wall-less venous cannula, 5–8 as well as its safety and superiority, has already been shown in in vivo animal and human and in vitro bench experiments. 1,8–12 Equally important in every CPB circuit is the damage to blood cells.…”

Section: Introductionmentioning

confidence: 99%

Single-Center Experience With a Self-Expandable Venous Cannula During Minimally Invasive Cardiac Surgery

Praet

Kofler

Meyer

et al. 2022

Innovations�(Phila)

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Objective: Venous drainage is often problematic in minimally invasive cardiac surgery (MICS). Here, we describe our experience with a self-expandable stent cannula designed to optimize venous drainage. Methods: The smart canula® was used in 58 consecutive patients undergoing MICS for mitral valve disease ( n = 40), left atrial myxoma ( n = 3), left ventricular outflow tract obstruction ( n = 1), and aortic valve replacement via a right anterior minithoracotomy ( n = 14) procedures. The venous cannula was placed under transesophageal echocardiography guidance to reach the superior vena cava. Vacuum-assisted venous drainage (between −20 and −35 mm Hg) was used to reach a target flow index of 2.2 L/min/m² at a core temperature of 34 °C using a goal-directed perfusion strategy aimed at a minimum DO2 of 272 mL/min/m2. Cardiopulmonary bypass (CPB) parameters were recorded, and hemolysis-related parameters were analyzed on postoperative days 1 to 7. Results: Mean body surface area and median body mass index were 1.9 ± 0.2 m2 and 25.2 (23.4, 30.2) kg/m2. Mean CPB and median cross-clamping times were 107.7 ± 24.4 min and 64.5 (53, 75.8) min, and median CPB flow during cardioplegic arrest was 4 (3.6, 4.2) L/min (median cardiac index 2.1 [2, 2.2] L/min/m²). Venous drainage was considered sufficient by the surgeon in all cases, and insertion and removal were uncomplicated. Mean SvO2 during CPB was 80.2% ± 5.5%, and median peak lactate was 10 (8, 14) mg/dL, indicating sufficient perfusion. Mean venous negative drainage pressure during cross-clamping was 27.2 ± 12.3 mm Hg. Platelets dropped by 73.6 ± 37.5 K/µL, lactate dehydrogenase rose by 81.5 (44.3, 140.8) U/L, and leukocytes rose by 3.4 (2.2, 7.2) K/µL on postoperative day 1. Conclusions: The venous smart canula® allows for optimal venous drainage at low negative drainage pressures, facilitating sufficient perfusion in MICS.

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

Cited by 5 publications

References 16 publications

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Effect of blood viscosity on the performance of virtually wall-less venous cannulas

Single-Center Experience With a Self-Expandable Venous Cannula During Minimally Invasive Cardiac Surgery

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