Augmented venous return for minimally invasive open heart surgery with selective caval cannulation

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Serval ID
serval:BIB_1D9E46E97113
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Augmented venous return for minimally invasive open heart surgery with selective caval cannulation
Journal
European Journal of Cardio-Thoracic Surgery
Author(s)
Jegger  D., Tevaearai  H. T., Horisberger  J., Mueller  X. M., Boone  Y., Pierrel  N., Seigneul  I., von Segesser  L. K.
ISSN
1010-7940 (Print)
Publication state
Published
Issued date
09/1999
Volume
16
Number
3
Pages
312-6
Notes
Clinical Trial
Journal Article --- Old month value: Sep
Abstract
OBJECTIVE: Minimally invasive open heart surgery involves limited intrathoracic cannulation sites necessitating cardiopulmonary bypass to be initiated via peripheral access using percutaneous cannulae with the tip placed into the right atrial cavity. However, surgery involving the opening of the right heart obliges the surgeon to maintain the end of the cannulae into the vena cavae. The impeded venous return due to the smaller diameter may be alleviated by inserting a centrifugal pump in the venous line. METHODS: Right anterior mini-thoracotomy and exposure of the femoral site were performed before the patient was heparinized. Cannulation of the femoral artery, the inferior vena cava via the femoral vein and the superior vena cava through the mini-thoracotomy was performed and cardiopulmonary bypass was initiated. Venous drainage was augmented with the centrifugal pump. Cardiac arrest was provoked and both vena cavae were snared before performing the intracardiac procedure. RESULTS: Twenty consecutive patients were operated on using this technique (15 males/five females; age: 44.8 +/- 14.3 years; bodyweight: 73.5 +/- 15.1 kg; body surface area: 1.8 +/- 0.2 m2; theoretical blood flow rate: 4.4 +/- 0.5 l/min). The cannula sizes were 21.9 +/- 2.2 Fr for the femoral artery, 26.5 +/- 1.7 Fr for the inferior vena cava and 23.8 +/- 2.5 Fr for the superior vena cava. Venous drainage through the single inferior vena cava cannula was 2.1 +/- 0.6 l/min (48.8 +/- 13.3% of the theoretical flow). Adding the superior vena cava cannula increased the venous flow to 3.1 +/- 0.4 l/min (70.7 +/- 9.6% of the theoretical value, P < 0.005). The use of the centrifugal pump increased the flow to 4.1 +/- 0.6 l/min (93.4 +/- 8.9% of the theoretical flow, P < 0.001) with a mean inlet negative pressure of -69 +/- 10.2 mmHg. The mean bypass time was 64.0 +/- 24.6 min for a mean operative time of 226.3 +/- 61.0 min. Minimum venous saturation was 69.4 +/- 8.5%. CONCLUSIONS: Despite the smaller diameter of the vena cavae compared to the right atrium, and a smaller internal diameter of percutaneous cardiopulmonary bypass cannulae compared to classic ones; the centrifugal pump improves the venous drainage significantly so that minimally invasive open heart procedures can be performed under optimal and safe perfusion conditions.
Keywords
Adult Cardiopulmonary Bypass/*methods/mortality Catheterization, Peripheral/*methods Coronary Disease/surgery Female Femoral Artery/*surgery Follow-Up Studies Humans Male Middle Aged Prospective Studies Surgical Procedures, Minimally Invasive/*methods/mortality Survival Rate Thoracotomy Treatment Outcome Vena Cava, Inferior/*surgery
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:28
Last modification date
25/09/2019 7:08
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