Routine use of self-expanding venous cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive cases

von Segesser, Ludwig K. ; Ferrari, Enrico ; Delay, Dominique ; Maunz, Olaf ; Horisberger, Judith ; Tozzi, Piergorgio

In: European Journal of Cardio-Thoracic Surgery, 2008, vol. 34, no. 3, p. 635-640

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    Summary
    Objective: Assess the performance of self-expanding venous cannulas for routine use in open-heart surgery. Methods: Prospective study in 100 unselected consecutive patients undergoing open-heart surgery with either remote or central smart venous cannulation. Results: The study focuses on the 76 consecutive adult patients (mean age 59.2±17.3 years; 60 males, 16 females) undergoing surgical procedures with total cardiopulmonary bypass for either valve procedures (42/76 patients=55.3%), ascending aorta and arch repair (20/76 patients=26.3%), coronary artery revascularization (13/76 patients=17.1%) or other procedures (11/76 patients=14.5%) with 14/76 patients (18.4%) undergoing redo surgery and 6/76 patients (7.9%) undergoing small access surgery. The mean pump flow achieved by gravity drainage alone accounted for 5.0±0.6l/min (=114% of target) in the entire study population (n=76) as compared to the calculated, theoretical pump flow of 4.4±0.5l/min (p<0.0001). For the femoral cannulation sub-group (n=35) pump flow achieved by gravity drainage alone accounted for 4.9±0.6l/min (=114% of target) as compared to the calculated theoretical pump flow of 4.3±0.4l/min (p<0.0001). The corresponding numbers for trans-subclavian cannulation (n=7) are 5.2±0.5l/min (111%) for the pump flow achieved by gravity drainage as compared to the theoretical target flow of 4.7±0.4l/min. For the central cannulation sub-group (n=34) mean flow achieved by gravity drainage with a self-expanding venous cannula accounted for 5.1±0.7l/min (=116% of target) as compared to the calculated theoretical flow of 4.4±0.6l/min (p<0.0001). Conclusion: Full or more than target flow was achieved in 97% of the patients studied undergoing CPB with self-expanding venous cannulas and gravity drainage. Remote venous cannulation with self-expanding cannulas provides similar flows as central cannulation. Augmentation of venous return is no longer necessary