A clinical comparison of bubble elimination in Quadrox and Polystan oxygenators

Background: Microbubbles generated during heart surgery on extracorporeal circulation have been implicated as a possible cause of postoperative neurocognitive dysfunction and negative outcome. The main sources of microbubbles in the extracorporeal circuit are air leaking from the venous cannulation site, air delivered by drug and volume administration, during the taking of blood samples, during hemofiltration, and by using vacuum-assisted venous drainage (VAVD). Membrane oxygenators, although not designed for the elimination of gaseous microbubbles, can eliminate much of this air. Aim of the study / hypothesis: The aim of this study was to test the hypothesis that the amount of microbubbles passing through the oxygenator varies depending on the oxygenator design. Methods: one hundred patients undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in a retrospective clinical trial assessing the bubble elimination of the two oxygenators routinely used in our clinic. The oxygenators (Quadrox-i Adult / Polystan Safe Maxi) are manufactured with the same hollow-fiber material, but display different designs. Bubbles were detected by a two-channel ultrasound bubble counter. The probes were placed directly at the inlet and the outlet of the oxygenators. The filtration index was calculated by the bubble counter as a measure of the percentage reduction of bubble volume and number. Results: The Quadrox has a significantly higher filtration index (92.3% [89.7; 95.1], median [25th,75th percentile]) than the Polystan (74.9% [64.2;80.9], p<0.001), indicating the superior ability of the Quadrox to eliminate microbubbles. Conclusion: Our study demonstrates major differences in the capacity of bubble elimination of the oxygenators being investigated, possibly depending on oxygenator design.

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Novel surgical management of an extensive recurrent Hickman line thrombosis involving the SVC and right atrium

10.22541/au.162669188.85479384/v1 ◽

2021 ◽

Author(s):

Anna Zingale ◽

Danai Karamanou ◽

Pietro Malvindi ◽

Suvitesh Luthra ◽

Sunil Ohri

Keyword(s):

Cardiopulmonary Bypass ◽

Small Bowel ◽

Right Atrium ◽

Circulatory Arrest ◽

Anticoagulation Therapy ◽

Venous Drainage ◽

Central Line ◽

Venous Cannulation ◽

Cannulation Site ◽

Intracardiac Thrombosis

Intravenous central line catheters are often at risk of line-related thrombosis. We report on how the cardiopulmonary bypass strategy was tailored to the particular anatomical challenges with the use of an unconventional venous cannulation site to optimise intraoperative venous drainage, improve surgical exposure and avoid circulatory arrest in a case with a complex intracardiac thrombosis. This report also highlights the importance of assiduously monitoring the efficacy of anticoagulation therapy, especially in the context of small bowel syndrome.

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RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

Journal of the American Heart Association ◽

10.1161/jaha.117.008077 ◽

2018 ◽

Vol 7 (7) ◽

Cited By ~ 8

Author(s):

Patrick Meybohm ◽

Madeline Kohlhaas ◽

Christian Stoppe ◽

Matthias Gruenewald ◽

Jochen Renner ◽

...

Keyword(s):

Ischemic Preconditioning ◽

Heart Surgery ◽

Myocardial Dysfunction ◽

Remote Ischemic Preconditioning ◽

Neurocognitive Dysfunction

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Risk of harlequin syndrome during bi-femoral peripheral VA-ECMO: should we pay more attention to the watershed or try to change the venous cannulation site?

Critical Care ◽

10.1186/s13054-020-03168-y ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Patrick M. Honore ◽

Leonel Barreto Gutierrez ◽

Luc Kugener ◽

Sebastien Redant ◽

Rachid Attou ◽

...

Keyword(s):

Venous Cannulation ◽

Harlequin Syndrome ◽

Cannulation Site ◽

Va Ecmo

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Comparative evaluation of Myolaxin and EM LA cream for attenuation of venous cannulation pain: A prospective, randomised, double blind study

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500511 ◽

2007 ◽

Vol 35 (5) ◽

pp. 726-729 ◽

Cited By ~ 6

Author(s):

A. Agarwal ◽

G. Yadav ◽

D. Gupta ◽

M. Tandon ◽

S. Dhiraaj ◽

...

Keyword(s):

Eutectic Mixture ◽

Similar Efficacy ◽

Blind Study ◽

Double Blind Study ◽

Dominant Hand ◽

Venous Cannulation ◽

Double Blind ◽

Suitable Alternative ◽

Group I ◽

Cannulation Site

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a Visual Analogue Scale (VAS) of O-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.

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Cardiopulmonary Bypass through a Left Thoracotomy Using Venous Drainage from the Innominate Vein in Congenital Heart Surgery

Journal of Cardiac Surgery ◽

10.1111/jocs.12165 ◽

2013 ◽

Vol 28 (5) ◽

pp. 591-594 ◽

Cited By ~ 1

Author(s):

Takaaki Suzuki ◽

Ayumu Masuoka ◽

Yoshimasa Uno ◽

Mika Iwazaki ◽

Syunsuke Yamagishi ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Congenital Heart ◽

Heart Surgery ◽

Venous Drainage ◽

Congenital Heart Surgery ◽

Innominate Vein ◽

Left Thoracotomy

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Monitoring and regulation of gas exchange in most-122 stationary membrane oxygenators during open heart surgery

Biomedical Engineering ◽

10.1007/bf00560766 ◽

1990 ◽

Vol 24 (4) ◽

pp. 171-174

Author(s):

A. B. Karasev ◽

P. N. Marinin ◽

S. B. Trukhmanov ◽

A. A. Pisarevskii

Keyword(s):

Gas Exchange ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Membrane Oxygenators ◽

Stationary Membrane

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Intraoperative Changes of Immunoglobulins and Complement Fractions During Open-heart Surgery Using Membrane Oxygenators

Cardiovascular Surgery 1980 ◽

10.1007/978-3-642-68172-1_60 ◽

1981 ◽

pp. 308-315 ◽

Cited By ~ 1

Author(s):

R. Lozano ◽

M. Navarro ◽

J. C. Salinas ◽

J. Suárez ◽

J. Revilla ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Membrane Oxygenators

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000083 ◽

2014 ◽

Vol 9 (4) ◽

pp. 297-301 ◽

Cited By ~ 4

Author(s):

Mhedi Belkoniene ◽

Saad Abdel-Sayed ◽

Julien Favre ◽

Ludwig-Karl Von Segesser

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Centrifugal Pump ◽

Invasive Surgery ◽

Heart Surgery ◽

Small Diameter ◽

Venous Drainage ◽

Superior Performance ◽

Set Up ◽

Q Values

Objective Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. Methods To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Results Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, −5.4, −15.9, −45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Conclusions Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

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