A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery.

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Serval ID
serval:BIB_5EFBEDCEFED0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Jegger D., Chassot P.G., Bernath M.A., Horisberger J., Gersbach P., Tozzi P., Delay D., von Segesser L.K.
ISSN
1010-7940
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
29
Number
4
Pages
525-529
Language
english
Abstract
OBJECTIVE: Transthoracic echocardiography (TTE) has been used clinically to disobstruct venous drainage cannula and to optimise placement of venous cannulae in the vena cava but it has never been used to evaluate performance capabilities. Also, little progress has been made in venous cannula design in order to optimise venous return to the heart lung machine. We designed a self-expandable Smartcanula (SC) and analysed its performance capability using echocardiography. METHODS: An epicardial echocardiography probe was placed over the SC or control cannula (CTRL) and a Doppler image was obtained. Mean (V(m)) and maximum (V(max)) velocities, flow and diameter were obtained. Also, pressure drop (DeltaP(CPB)) was obtained between the central venous pressure and inlet to venous reservoir. LDH and Free Hb were also compared in 30 patients. Comparison was made between the two groups using the student's t-test with statistical significance established when p<0.05. RESULTS: Age for the SC and CC groups were 61.6+/-17.6 years and 64.6+/-13.1 years, respectively. Weight was 70.3+/-11.6 kg and 72.8+/-14.4 kg, respectively. BSA was 1.80+/-0.2 m(2) and 1.82+/-0.2 m(2), respectively. CPB times were 114+/-53 min and 108+/-44 min, respectively. Cross-clamp time was 59+/-15 min and 76+/-29 min, respectively (p=NS). Free-Hb was 568+/-142 U/l versus 549+/-271 U/l post-CPB for the SC and CC, respectively (p=NS). LDH was 335+/-73 mg/l versus 354+/-116 mg/l for the SC and CC, respectively (p=NS). V(m) was 89+/-10 cm/s (SC) versus 63+/-3 cm/s (CC), V(max) was 139+/-23 cm/s (SC) versus 93+/-11 cm/s (CC) (both p<0.01). DeltaP(CPB) was 30+/-10 mmHg (SC) versus 43+/-13 mmHg (CC) (p<0.05). A Bland-Altman test showed good agreement between the two devices used concerning flow rate calculations between CPB and TTE (bias 300 ml+/-700 ml standard deviation). CONCLUSIONS: This novel Smartcanula design, due to its self-expanding principle, provides superior flow characteristics compared to classic two stage venous cannula used for adult CPB surgery. No detrimental effects were observed concerning blood damage. Echocardiography was effective in analysing venous cannula performance and velocity patterns.
Keywords
Adult, Aged, Anthropometry, Cardiopulmonary Bypass, Catheterization, Central Venous, Coronary Artery Bypass, Echocardiography, Doppler, Equipment Design, Female, Hemoglobins, Humans, Intraoperative Care, Lactate Dehydrogenases, Male, Middle Aged, Vena Cava, Inferior
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 11:43
Last modification date
25/09/2019 7:09
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