Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Kirsch, Matthias; Zannis, Kostantinos; Ali, Firas; Vermès, Emmanuelle; Bajan, G.; Loisance, D

doi:10.1016/j.ejcts.2007.11.022

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…18,19 However, at negative pressures up to −40 mm Hg, there was no difference compared to drainage by gravity. 20 Similar reports are available for the clinical setting, 21 where not only additional gaseous embolic load but also excessive hemolysis are an issue, 21 a phenomenon being also known for a long time. 22 This latter concern has proven to be unfounded for the stent-type design of the virtually wall-less cannulas studied here as demonstrated previously for its use in combination with gravity drainage 6,23 as well as with augmented venous drainage.…”

Section: Discussionmentioning

confidence: 88%

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Segesser

Berdajs

Abdel-Sayed

et al. 2016

Innovations�(Phila)

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Objective Inadequate venous drainage during minimally invasive cardiac surgery becomes most evident when the blood trapped in the pulmonary circulation floods the surgical field. The present study was designed to assess the in vivo performance of new, thinner, virtually wall-less, venous cannulas designed for augmented venous drainage in comparison to traditional thin-wall cannulas. Methods Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with percutaneous venous access over the wire, serial dilation up to 18 F and insertion of either traditional 19 F thin wall, wire-wound cannulas, or through the same access channel, new, thinner, virtually wall-less, braided cannulas designed for augmented venous drainage. A standard minimal extracorporeal circuit set with a centrifugal pump and a hollow fiber membrane oxygenator, but no inline reservoir was used. One hundred fifty pairs of pump-flow and required pump inlet pressure values were recorded with calibrated pressure transducers and a flowmeter calibrated by a volumetric tank and timer at increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments). Results Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45 l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM, 5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for 9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, −42.4 ± 26.7 versus −123 ± 51.1 at 2500 RPM, and −126.7 ± 55.3 versus −313 ±116.7 for 3500 RPM. Conclusions At the well-accepted pump inlet pressure of −80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings.

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Section: Discussionmentioning

confidence: 88%

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Segesser

Berdajs

Abdel-Sayed

et al. 2016

Innovations�(Phila)

View full text Add to dashboard Cite

show abstract

“…Although some in vitro studies found a correlation between the augmented venous drainage with either a vacuum or a centrifugal pump as well as the incidence of micro-embolism in the arterial line [ 15 , 16 ] at a negative pressure up to −40 mmHg, there were no differences compared to gravity venous drainage, especially in the clinical setting [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Virtually Wall-Less versus Standard Thin-Wall Venous Cannula in the Minimally Invasive Mitral Valve Surgery: Single-Center Experience

et al. 2023

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Background and Objectives: Minimally invasive cardiac surgery (MICS) has been developing since 1996. Peripheral cannulation is required to perform MICS, and good venous drainage and a bloodless field are crucial for the success of this procedure. We assessed the benefits of using a virtually wall-less cannula in comparison with the standard thin-wall cannula in clinical practice. Materials and Methods: Between January 2021 and December 2022, we evaluated 65 elective patients, who underwent isolated minimally invasive mitral valve surgery. Both the virtually wall-less and the thin-wall cannulas were placed through a surgical cut-down. Patients’ characteristics at baseline were similar in the two groups, except for the body surface area (BSA), which was greater in the virtually wall-less group compared to the thin-wall one. In the standard group, the size of the cannula was chosen depending on the patient’s BSA, and the choice of the Smartcannula was based on their height. Results: There were no significant differences between the two groups in terms of negative pressure applied, target flow achieved, hemolysis, the need for blood transfusion, and the post-operative increases in liver and renal enzymes. However, in all the patients, the estimated target flow was achieved, thereby showing the better hemodynamic performance of the virtually wall-less cannula, since, in this group, the patients’ BSA was significantly greater compared to the thin-wall group. Ultimately, the mean cross-clamp time, as an indirect index of the effectiveness of the venous drainage, is shorter in the virtually wall-less group compared with the thin-wall group. Conclusions: The virtually wall-less cannula should be preferred in minimally invasive mitral valve surgery due to its superior performance in terms of venous drainage compared with the standard thin-wall cannula.

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“…1 Thus, improved venous drainage has the potential to simplify the surgical procedure. 2 While poor drainage is a concern, excessive drainage may also problematic, 3 as it leads to a collapse of the venous wall around the end of the venous cannula and/or its orifices; this collapse phenomenon is called "chattering" or "fluttering, " and it results in intermittent interruption and overall reduction of venous drainage. Hydrodynamic analysis of venous cannulas on a bench is a valuable technique to evaluate their performance during CPB.…”

Section: Introductionmentioning

confidence: 99%

Effect of blood viscosity on the performance of virtually wall-less venous cannulas

Abdel-Sayed

Berdaj

et al. 2019

Perfusion

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Aim: This study was designed to quantify the influence of blood as test medium compared to water in cannula bench performance assessment. Methods: An in vitro circuit was set-up with silicone tubing between two reservoirs. The test medium was pumped from the lower reservoir by centrifugal pump to the upper reservoir. The test-cannula was inserted in a silicone tube connected between the lower reservoir and the centrifugal pump. Flow rate and pump inlet-pressure were measured for wall-less versus thin-wall cannula using a centrifugal pump in a dynamic bench-test for an afterload of 40-60 mmHg using two media: blood 10 g/dL and 5.6 g/dL and water 0 g/dL. Results: The wall-less cannula showed significantly higher flows rates as compared to the thin-wall cannula (control), with both hemoglobin concentrations and water. Indeed, for a target volume of 200-250 mL of blood (Hg 10 g/dL) in the upper reservoir, the cannula outlet pressure (P) was −14 ± 14 mmHg versus −18 ± 11 mmHg for the wall-less and control respectively; the cannula outlet flow rate (Q) was 3.91 ± 0.41 versus 3.67 ± 0.45 L/min, respectively. At the same target volume but with a Hg of 5.7 g/dL, P was −16 ± 12 mmHg versus −19 ± 12 mmHg and Q was 4 ± 0.1 versus 4 ± 0.4 L/min for the wall-less cannula and control respectively. Likewise, P and Q values with water were −1 mmHg versus −0.67 ± 0.58 mmHg and 4.17 ± 0.45 L/min versus 4.08 ± 0.47 L/min for the wall-less and control respectively. Conclusion: Walls-less cannula showed 5.6% less pump inlet-pressure differences calculated between blood and water, as compared to that of thin-wall cannula (−21 times). Flow differences were 6% and 10% for the walls-less and thin-wall cannula respectively. We conclude that testing the cannula performance with water is a good scenario and can overestimate the flow by a 10%. However, superiority for wall-less is preserved with both water and blood.

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Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

Cited by 8 publications

References 15 publications

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

New, Virtually Wall-Less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery

Virtually Wall-Less versus Standard Thin-Wall Venous Cannula in the Minimally Invasive Mitral Valve Surgery: Single-Center Experience

Effect of blood viscosity on the performance of virtually wall-less venous cannulas

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