Vacuum Assisted Venous Drainage Does Not Increase Trauma to Blood Cells

Abstract

Although gravity drainage has been the standard technique for cardiopulmonary bypass (CPB), the development of min imally invasive techniques for cardiac surgery has renewed interest in using vacuum assisted venous drainage (VAVD) Dideco (Mirandola, Italy) has modified the D903 Avant oxygenator to apply a vacuum to its venous reservoir. The impact of VAVD on blood damage with this device is analyzed. Six calves (mean body weight, 71.3 +/- 4.1 kg) were con nected to CPB by jugular venous and carotid arterial cannu lation, with a flow rate of 4-4.51 L/min for 6 h. They were assigned to gravity drainage (standard D903 Avant oxygen ator, n = 3) or VAVD (modified D903 Avant oxygenator, n = 3). The animals were allowed to survive for 7 days. A standard battery of blood samples was taken before bypass, throughout bypass, and 24 h, 48 h, and 7 days after bypass. Analysis of variance was used for repeated measurements. Thrombocyte and white blood cell counts, corrected by hematocrit and normalized by prebypass values, were not significantly different between groups throughout all study periods. The same holds true for hemolytic parameters (lactate dehydrogenase [LDH] and plasma hemoglobin). Both peaked at 24 hr in the standard and VAVD groups: LDH, 2,845 +/- 974 IU/L vs. 2,537 +/- 476 IU/L (p = 0.65), respectively; and plasma hemoglobin, 115 +/- 31 mg/L vs. 89 +/- 455 mg/L (p = 0.45), respectively. In this experimental setup with prolonged perfusion time, VAVD does not increase trauma to blood cells in comparison with standard gravity drainage.

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

“…We have observed a nearly two-fold increase in FFP and platelet transfusion in patients undergoing KAVD. One contributing factor might be increased blood trauma due to venous line vacuum or more intense blood activation by the contact with air, although experimental [17] and clinical [14] data using vacuum assisted venous drainage do not support this hypothesis.…”

Clinical Experience with Assisted Venous Drainage Cardiopulmonary Bypass in Elective Cardiac Reoperations

“…A tear in the right ventricle may be impossible to repair without decompression. Catastrophic hemorrhage leading to death as a consequence of structural injury has been reported [Mueller 2001]. Dobell and Jain [1984] surveyed 224 surgeons and reported a 37% mortality rate.…”

Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the Symmetry Aortic Connector System

“…A vacuum-assisted venous return was effective in yielding adequate heart decompression without the need for additional heart venting in the remaining cases. 6 The pericardium was opened longitudinally from the apex to the ascending aorta, and in reoperations lysis of adhesions was completed with bipolar scissors (Powerstar; Ethicon Inc, Somerville, NJ). Patent ITA isolation seemed to be more straightforward through a left thoracotomy.…”