Practical techniques Vacuum-assisted venous return in pediatric cardiopulmonary bypass

Abstract

Vacuum-assisted venous return (VAVR) has been reported to offer benefits for adults undergoing cardiopulmonary bypass (CPB), such as improved venous return, lowering priming volume (by eliminating the need to prime the venous line), and the use of smaller venous cannulae. All these benefits would be of particular value in pediatric perfusion because of the unique challenges of these smaller patients and the relatively large components of the CPB circuit. We have been using VAVR in children since the early summer of 1998 after we became comfortable with the technique and convinced of its efficacy in adults. Ours is a medium-sized pediatric caseload of slightly more than 100 CPB cases per year. With that caseload, it is most effective for us to minimize the inventory of different sizes of disposables used. We have opted for an oxygenator/reservoir that has a maximum flow of 4 liters with a priming volume of about 1 liter. We have been unhappy with the large prime volume in infants and earlier, in 1997-1998, were using a smaller prime oxygenator/reservoir until it was recalled. Faced again with a larger priming volume in the infants, we decided to try vacuum to decrease hemodilution and to evaluate other possible benefits. Through the use of VAVR, we have been able to decrease our priming volume, use smaller venous cannulae, and have more consistent return while experiencing no adverse effects of VAVR in our pediatric cardiac surgery patients.

Vacuum-Assisted Venous Drainage in Complex Congenital Cardiac Surgery

“…However, the experimental finding of an increased risk for systemic air embolism has to be kept in mind, and a careful evaluation of which technique is best to apply has to be performed in each individual case. In paediatric cardiac surgery, VAVD has been applied without complications by different groups [1,6].…”

A Surgeon's Perspective on Blood Conservation Practice in Pediatric Cardiac Surgery

“…33 This technique has been shown to be safe with proven ability to reduce homologous blood transfusion in pediatric cardiac surgery. 34–37…”

“…33 This technique has been shown to be safe with proven ability to reduce homologous blood transfusion in pediatric cardiac surgery. [34][35][36][37] Ultrafiltration. There are two forms of ultrafiltration.…”

Blood Conservation in Pediatric Cardiac Surgery

“…Small circuits with a remote pump head allow for a reduction in priming volume to 200 to 250 mL in neonates when 3/16 " tubing is used. Small circuits and assisted vacuum-assisted venous return (VAVR) 25 have made it possible to decrease the priming volume in both piglets 22 and in neonates 26 to 107 mL and to 190 mL, respectively. Personal experience and observations have shown that in a neonate with a 300 mL blood volume and a 45% Hct, Hct will decrease to 19% if the circuit priming volume is 400 mL with a clear prime; Hct will decrease to 27% if the circuit priming volume is only 200 mL.…”