Caval collapse during cardiopulmonary bypass: a reproducible bench model.

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Serval ID
serval:BIB_6562FDD88F2A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Caval collapse during cardiopulmonary bypass: a reproducible bench model.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Li L., Abdel-Sayed S., Berdajs D., Tozzi P., von Segesser L.K., Ferrari E.
ISSN
1010-7940
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
46
Number
2
Pages
306-312
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
OBJECTIVES: During open heart surgery, so-called atrial chatter, a phenomenon due to right atria and/or caval collapse, is frequently observed. Collapse of the cava axis during cardiopulmonary bypass (CPB) limits venous drainage and may result downstream in reduced pump flow on (lack of volume) and upstream in increased after-load (stagnation), which in turn may both result in reduced or even inadequate end-organ perfusion. The goal of this study was to reproduce venous collapse in the flow bench.
METHODS: In accordance with literature for venous anatomy, a caval tree system is designed (polyethylene, thickness 0.061 mm), which receives venous inflow from nine afferent veins. With water as medium and a preload of 4.4 mmHg, the system has an outflow of 4500 ml/min (Scenario A). After the insertion of a percutaneous venous cannula (23-Fr), the venous model is continuously served by the afferent branches in a venous test bench and venous drainage is augmented with a centrifugal pump (Scenario B).
RESULTS: With gravity drainage (siphon: A), spontaneously reversible atrial chatter can be generated in reproducible fashion. Slight reduction in the outflow diameter allows for generation of continuous flow. With augmentation (B), irreversible collapse of the artificial vena cava occurs in reproducible fashion at a given pump speed of 2300 ± 50 RPM and a pump inlet pressure of -112 mmHg. Furthermore, bubbles form at the cannula tip despite the fact that the entire system is immersed in water and air from the environment cannot enter the system. This phenomenon is also known as cavitation and should be avoided because of local damage of both formed blood elements and endothelium, as well embolization.
CONCLUSIONS: This caval model provides a realistic picture for the limitations of flow due to spontaneously reversible atrial chatter vs irreversible venous collapse for a given negative pressure during CPB. Temporary interruption of negative pressure in the venous line can allow for recovery of venous drainage. This know-how can be used not only for testing different cannula designs, but also for further optimizing perfusion strategies.
Pubmed
Web of science
Open Access
Yes
Create date
09/01/2015 20:09
Last modification date
25/09/2019 6:09
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