Venous drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage

Abstract

Vacuum-assisted venous drainage (VAVD) can facilitate venous drainage in single-access minimally invasive cardiac surgery (SAMICS). We retrospectively examined the use of VAVD in SAMICS in our hospital for this report. VAVD has been performed according to a VAVD protocol since 2000. Data from the 110 patients who underwent SAMICS in our institute from January 2000 to June 2002 were reviewed retrospectively. The total negative pressure was maintained at no greater than -90 mmHg. Indications for use of VAVD (protocol) were: insufficient venous return by siphon drainage alone, persistent elevation of the central venous pressure (CVP), and, insufficient venous drainage in the operative field. Of 110 patients, 97 (88.2%) underwent VAVD. The body surface area was significantly smaller in the group that did not require VAVD (the non-VAVD group) than in the group that did (VAVD group) (VAVD group versus non-VAVD group: 1.586 +/- 0.175 versus 1.408 +/- 0.153 m(2), P < 0.001). Other factors such as cardiopulmonary bypass time, aortic cross-clamp time, postoperative maximum lactate dehydrogenase, postoperative maximum creatinine, postoperative maximum blood urea nitrogen were similar in the two groups. VAVD is necessary in SAMICS except for small patients. A VAVD total negative pressure of -90 mmHg did not hinder operative procedures or cause clinical problems.

Drenagem venosa assistida a vácuo na circulação extracorpórea e necessidade de hemotransfusão: experiência de serviço

“…Thanks to technological advancements that now allow for the development of minimally invasive cardiac surgery, where the technique of VAVD has been essential safely and effectively [7][8][9][10], is also increasing the number of studies on the use of this technique in cardiac surgery of access and traditional cannulation. In this sense, these authors cite several benefits gained by the substitution of conventional drainage, which is based on sinfonagem and gravity drainage by using the active vacuum [11][12][13][14][15][16][17].…”

“…This may indicate the need for greater care with this group of patients, translated by better planning of which technique to use, as well as strategies to avoid the use of red blood cells or reduce it to the maximum possible. However, studies on the use of VAVD decision based on the trial of the perfusionist in partnership with the surgeon, according to the criteria evaluated during the course of CPB, found a low percentage of patients with low weight and body surface in those who required the use of the technique [9]. Another clinical benefit reported in the literature refers to VAVD refers to efficient decompression cardiac surgery field by offering a more appropriate, as a result of venous drainage effective, regardless of positioning and handling of the heart [15][16][17].…”

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

“…The other authors cited confirm the possibility of embolism, however claim to be controllable the risks of this involvement, since the perfusionist has knowledge of the applied technique, knowing the limitations and risks involved. Even with increased chances of accidents, Carrier et al [ 32 ] and Murai et al [ 25 ] argue that the use of vacuum does not increase the chance of neurological and general complications, confirming the theory that the risks can be controlled.…”

“…There was disagreement with respect to generation of hemolysis by the use of a vacuum. Most authors [ 16 , 18 , 20 , 22 - 25 ] considers that hemolysis caused in procedures with negative pressure procedures were similar to hemolysis in gravitational drainage. However, when comparing vacuum drainage with drainage by centrifugal pump, Cirri et al.…”

Abordagem da valva do tronco pulmonar por desvio direito e uso de cânula bicaval: estudo experimental

“…The vacuum-assisted venous drainage of the container was not necessary in order to improve drainage as described by some authors [20,21].…”