Augmented venous return for minimally invasive open heart surgery with selective caval cannulation
Détails
Etat: Public
Version: Final published version
Licence: Non spécifiée
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
ID Serval
serval:BIB_1D9E46E97113
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Augmented venous return for minimally invasive open heart surgery with selective caval cannulation
Périodique
European Journal of Cardio-Thoracic Surgery
ISSN
1010-7940 (Print)
Statut éditorial
Publié
Date de publication
09/1999
Volume
16
Numéro
3
Pages
312-6
Notes
Clinical Trial
Journal Article --- Old month value: Sep
Journal Article --- Old month value: Sep
Résumé
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.
Mots-clé
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
Oui
Création de la notice
28/01/2008 10:28
Dernière modification de la notice
14/02/2022 8:54