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

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.

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

2016 ◽  
Vol 11 (4) ◽  
pp. 278-281 ◽  
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.

Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey

2012 ◽  
Vol 7 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Edward Y. Chan ◽  
Dennis M. Lumbao ◽  
Alexander Iribarne ◽  
Rachel Easterwood ◽  
Jonathan Y. Yang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Vena Cava ◽  
Minimally Invasive Cardiac Surgery ◽  
Aortic Occlusion ◽  
Complication Rates ◽  
Venous Cannulation ◽  
Arterial Cannulation ◽  
Dual Stage ◽  
Over Time

Objective For minimally invasive cardiac surgery (MICS) procedures requiring cardiopulmonary bypass (CPB), cannulation techniques vary and seem to be important determinants of technical difficulty and clinical outcomes. Over 10 years of MICS, we have modified our techniques substantially, and the present report outlines the evolution of our current cannulation platform. Methods From October 2000 to November 2010, 1087 minimally invasive cardiac procedures were performed at our institution; of these, 165 were done without CPB and were excluded. Methods of arterial and venous cannulation and aortic occlusion were retrospectively reviewed. Outcomes of interest included CPB and aortic cross-clamp time, as well as rates of in-hospital stroke, myocardial infarction, and short- and long-term mortality. Results The mean age of the study population was 57 ± 15 years, with 50% being men. The MICS procedures included mitral valve surgery, atrial septal defect repair, atrial fibrillation ablation, and cardiac tumor resections. Over the study period, peripheral arterial cannulation was replaced by central aortic cannulation, which was used in 33% of patients in 2000–2001 and 93% in 2008–2010. Venous cannulation strategies also evolved over time, from percutaneous neck and femoral (78% of cases from 2000–2005), to direct superior vena cava and percutaneous femoral (67% in 2006–2007), to percutaneous dual-stage femoral (51% in 2008–2010). Aortic occlusion was achieved by endoaortic balloon in 33% of cases in 2000–2001 but, by 2002, was replaced by transaxillary clamp occlusion and direct antegrade/retrograde cardioplegia. In the post-endoballoon era, CPB and cross-clamp times have remained consistent. Overall, there were nine strokes (<1.0%), no myocardial infarctions, and 18 deaths (2.0%) within 30 days of surgery, and the incidence of these outcomes has not changed over time. Conclusions Over 10 years, our cannulation strategy for MICS has evolved to favor central aortic over femoral arterial cannulation, percutaneous femoral dual-stage bicaval venous drainage over percutaneous neck access, and transaxillary clamping over endoaortic balloon occlusion of the aorta. In our experience, this approach has resulted in low complication rates and a reliable platform for a variety of MICS procedures.

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

2016 ◽  
Vol 11 (4) ◽  
pp. 278-281 ◽  
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

Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

2018 ◽  
Vol 13 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Vivek A. Wadhawa ◽  
Kartik G. Patel ◽  
Chirag P. Doshi ◽  
Jigar K. Shah ◽  
Jaydip A. Ramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Superior Vena Cava ◽  
Femoral Artery ◽  
Superior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Pediatric Cardiac Surgery

Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

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

2003 ◽  
Vol 6 (1) ◽  
pp. 20-24 ◽  
Author(s):  
H. Kiyama ◽  
T. Imazeki ◽  
Y. Katayama ◽  
N. Murai ◽  
M. Mukouyama ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Venous Drainage ◽  
Minimally Invasive Cardiac Surgery ◽  
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