CARDIOPULMONARY BYPASS USING VACUUM SYSTEM FOR VENOUS DRAINAGE WITH PRESSURE RELIEF VALVE FOR MINIMALLY INVASIVE CARDIAC SURGERY

The diffusion of minimally invasive cardiac surgery (MICS) during open-heart surgery has increased the use of assisted venous drainage support for cardiopulmonary bypass (CPB). Peripheral cannulation with small cannulae and vacuum-assisted venous drainage (VAVD) during MICS has been adopted in our institution since 1998. After the Heartport technique (HP) experience, the trans-thoracic clamp technique is now currently used. The aim of this study is to report our experience with extrathoracic CPB with VAVD application (on CPB) during open-heart MICS. From October 1999 to June 2006, 193 patients underwent MICS. Thirty-seven (19.2%) patients were treated with the HP - 13 (35%) with robotic technology and 156 (80.8%) with trans-thoracic aortic clamping (TTAC). Mean age was 39 years (range: 12-77), and 114 patients (59.1%) were female. A total of 128 patients (66.3%) underwent mitral valve surgery, 57 (29.6%) atrial septal defect closure, five (2.6%) cardiac mass removal, and three (1.5%) tricuspid valve repair. Four patients (2.0%) had a previous cardiac procedure. Peripheral CPB was established with a standard coated circuit. A 14 Fr arterial cannula was inserted into the right jugular vein and positioned at the atrial/superior vena cava junction. A 21 or 28 percutaneous femoral cannula, depending on body surface area, was inserted in the femoral vein and an arterial cannula in the right femoral artery. Gravitational drainage was combined with VAVD. To improve the safety and effectiveness of this technique, we monitored the pressure on each venous cannula and in the reservoir. The mean CPB time was 74.8∓30 min (TTAC) and 119∓48 min (HP); mean aortic clamping time was 51∓19 min (TTAC) and 73∓29 min (HP). We did not record any neurological complication. Two patients (1.0%), one from each group, were converted to sternotomy. Three patients (1.5%) underwent re-exploration for bleeding. In-hospital mortality was 0.5% (N = 1) (HP). Mechanical ventilation time and intensive care unit stay were comparable to those recorded with conventional sternotomy. In conclusion, we found that extrathoracic CPB and VAVD during trans-thoracic clamping is a safe, simple, and effective technique for MICS. However, there is a potential risk of haemolysis and air embolism, which can be prevented with vacuum monitoring, and with the addition of gravitational drainage to reduce vacuum pressure.

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451601100408 ◽

2016 ◽

Vol 11 (4) ◽

pp. 278-281 ◽

Cited By ~ 1

Author(s):

Ludwig Karl von Segesser ◽

Denis Berdajs ◽

Saad Abdel-Sayed ◽

Piergiorgio Tozzi ◽

Enrico Ferrari ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Venous Drainage ◽

Minimally Invasive Cardiac Surgery

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000283 ◽

2016 ◽

Vol 11 (4) ◽

pp. 278-281 ◽

Cited By ~ 3

Author(s):

Ludwig Karl von Segesser ◽

Denis Berdajs ◽

Saad Abdel-Sayed ◽

Piergiorgio Tozzi ◽

Enrico Ferrari ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Hollow Fiber Membrane ◽

Venous Drainage ◽

Minimally Invasive Cardiac Surgery ◽

Inlet Pressure ◽

Thin Wall ◽

Pump Flow ◽

Pump Inlet

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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Pressure difference between radial and femoral artery pressure in minimally invasive cardiac surgery using retrograde perfusion

The International Journal of Artificial Organs ◽

10.1177/0391398818784791 ◽

2018 ◽

Vol 41 (10) ◽

pp. 635-643 ◽

Cited By ~ 2

Author(s):

Yoshitsugu Nakamura ◽

Sam Emmanuel ◽

Fumiaki Shikata ◽

Chihiro Shirai ◽

Yujiro Ito ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Arterial Pressure ◽

Minimally Invasive ◽

Femoral Artery ◽

Systolic Arterial Pressure ◽

Minimally Invasive Cardiac Surgery ◽

Pressure Differential ◽

Artery Pressure ◽

Retrograde Perfusion

Objective: To investigate whether radial artery pressure is a reliable surrogate measure of central arterial pressure as approximated by femoral artery pressure in minimally invasive cardiac surgery with retrograde perfusion via femoral cannulation. Method: Fifty-two consecutive patients undergoing minimally invasive cardiac surgery were prospectively included in this study. Cardiopulmonary bypass was established via a femoral artery cannulation and femoral vein. Radial and femoral arterial pressures were recorded continuously, and the pressure differential between them was calculated for both systolic and mean arterial pressures. The agreement between measurements from the two arteries was compared using Bland–Altman plots. An interval of 95% limits of agreement of less than 20 mm Hg was set as satisfactory agreement. Results: Average age was 65 ± 14 years. With respect to systolic arterial pressure, 28 patients (54%) had a peak pressure differential between radial and femoral arteries ⩾20 mm Hg. With respect to mean arterial pressure, only five patients (9%) had a peak pressure differential ⩾20 mm Hg. The pressure differential changed with time. Pressure differential in systolic arterial pressure was 5 ± 8 mm Hg until aortic declamping, then increased to a peak of 23 ± 16 mm Hg when cardiopulmonary bypass was turned off. The femoral systolic arterial pressures were significantly greater than radial systolic arterial pressures from time of aortic declamping to 20 min after cardiopulmonary bypass. The Bland–Altman plots revealed large biases and poor agreement in this period. Conclusion: Radial and femoral systolic artery pressure readings can differ significantly in minimally invasive cardiac surgery with retrograde perfusion. Intraoperative arterial pressure management based solely on radial systolic arterial pressure readings should be avoided.

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Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery

Heart and Vessels ◽

10.1007/s00380-019-01365-6 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1280-1286

Author(s):

Ryosuke Muraki ◽

Toshinori Totsugawa ◽

Kazuyuki Nagata ◽

Kosuke Nakajima ◽

Tomoya Oshita ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Minimally Invasive Cardiac Surgery ◽

Cell Salvage

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Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery

Journal of Artificial Organs ◽

10.1007/s100470300003 ◽

2003 ◽

Vol 6 (1) ◽

pp. 20-24 ◽

Cited By ~ 5

Author(s):

H. Kiyama ◽

T. Imazeki ◽

Y. Katayama ◽

N. Murai ◽

M. Mukouyama ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Venous Drainage ◽

Minimally Invasive Cardiac Surgery ◽

Single Access

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Correction to: Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery

Heart and Vessels ◽

10.1007/s00380-019-01396-z ◽

2019 ◽

Vol 34 (8) ◽

pp. 1287-1287

Author(s):

Ryosuke Muraki ◽

Toshinori Totsugawa ◽

Kazuyuki Nagata ◽

Kosuke Nakajima ◽

Tomoya Oshita ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Minimally Invasive Cardiac Surgery ◽

Cell Salvage

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Clinical Experience in Minimally Invasive Cardiac Surgery with Virtually Wall-Less Venous Cannulas

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000478 ◽

2018 ◽

Vol 13 (2) ◽

pp. 104-107

Author(s):

Enrico Ferrari ◽

Ludwig K. von Segesser ◽

Denis Berdajs ◽

Ludwig Müller ◽

Maximilian Halbe ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Superior Vena ◽

Vena Cava ◽

Venous Drainage ◽

Minimally Invasive Cardiac Surgery ◽

Thin Wall ◽

Venous Cannulation ◽

Pump Speed ◽

Surgical Field

Objective Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS) is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed. The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS. Methods Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530–630-mm ST) was performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3), and other (4) procedures (combinations possible). Before transfemoral insertion of wall-less cannulas, a guidewire was positioned in the superior vena cava under echocardiographic control. The wall-less cannula was then fed over the wire and connected to a minimal extracorporeal system. Vacuum assist was used to reach a target flow of 2.4 l/min per m2 with augmented venous drainage at less than −80 mm Hg. Results Wall-less venous cannulas measuring either 630 mm (n = 8) in length or 530 mm (n = 2) were successfully implanted in all patients. For a body size of 173 ± 11 cm and a body weight of 78 ± 26 kg, the calculated body surface area was 1.94 ± 0.32 m2. As a result, the estimated target flow was 4.66 ± 0.78 l/min, whereas the achieved flow accounted for 4.98 ± 0.69 l/min (107% of target) at a vacuum level of 21.3 ± 16.4 mm Hg. Excellent exposure and “dry” intracardiac surgical field resulted. Conclusions The performance of virtually wall-less venous cannulas designed for augmented peripheral venous drainage was tested in MICS and provided excellent flows at minimal vacuum levels, confirming an increased performance over traditional thin wall cannulas. Superior results can be expected for routine use.

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