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

Abstract

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.