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Silvano R, Malvindi PG, Mazzocca F, Genova S, Di Campli E, Paterna F, D'Este JM, Alfonsi J, Berretta P, Munch C, Di Eusanio M. Vacuum assisted and gravitational venous drainage in aortic valve surgery: A propensity-match study. Perfusion 2024:2676591241230610. [PMID: 38272458 DOI: 10.1177/02676591241230610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Vacuum assisted venous drainage (VAVD) is widely adopted in minimally invasive cardiac surgery. VAVD enables the advantage of using smaller cannulae in a reduced surgical field while allowing satisfactory drainage and pump flow. The production of gaseous micro-emboli is a recognized risk associated with VAVD, however no difference in clinical endpoints have been reported between patients operated on with gravity venous drainage (GVD) or with VAVD. Due to the paucity of data on selected surgical populations, we sought to evaluate the early outcomes of patients undergoing isolated aortic valve replacement using VAVD or GVD. METHODS Data on 521 patients between 09/2016 and 09/2022 were retrieved from our internal database. Patients were divided into two groups according to use VAVD or GVD. A propensity match analysis was performed to account for difference between the two groups. RESULTS The propensity match provided two well balanced cohorts with 129 patients each. A minimally invasive access was used in 97% of the cases in VAVD group vs 98% in GVD group (p = .68). Mean cardiopulmonary by-pass (CPB) time was 71 vs 73 min (p = .74), respectively. There was no difference in lactates peak (p = .19) and urine output during CPB (p = .74). We registered two in-hospital deaths in VAVD cohort (1.6%) vs. no mortality in GVD group (p = .5). Postoperative cerebral stroke occurred in 1 patient in GVD cohort vs. 0 in VAVD (p = 1). Severe postoperative acute kidney injury complicated the course in 16 patients in GVD group and in 5 patients who had VAVD (p = .012). VAVD was associated with a higher number of patients with elevated postoperative AST (p = .07) and Troponin I (p = .01) values. CONCLUSIONS The use of VAVD during isolated aortic valve replacement was not associated with increased risks of postoperative complications and in-hospital mortality with results that were at least similar to those registered in a matched cohort of patients operated on with GVD.
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Affiliation(s)
- Raffaele Silvano
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Mazzocca
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Stefania Genova
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Emanuele Di Campli
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Francesca Paterna
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Jacopo M D'Este
- Perfusion Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Christopher Munch
- Anesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, University Hospital of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Kuleshov AP, Buchnev AS, Drobyshev AA, Esipova OY, Itkin GP. Development of a cannula device for gas fraction removal in surgical drains. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2022. [DOI: 10.15825/1995-1191-2022-4-46-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The development of low-traumatic surgical drains aimed at maximum possible separation of blood and air, is an important trend in modern medicine. The objective of this work is to create an inexpensive, user-friendly and low-traumatic dynamic blood aspiration system (DBAS). The system allows effective separation of blood and air when drawing blood from a wound under vacuum conditions required for blood aspiration. The operating principle of the system is to separate liquid and gas fractions of the blood-air mixture by modifying the blood intake cannula. The effect is achieved by applying the principles of centrifugal forces of a rotating blood-air flow combined with Archimedes lift forces.
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Affiliation(s)
- A. P. Kuleshov
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - A. S. Buchnev
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - A. A Drobyshev
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - O. Yu. Esipova
- Shumakov National Medical Research Center of Transplantology and Artificial Organs
| | - G. P. Itkin
- Shumakov National Medical Research Center of Transplantology and Artificial Organs; Moscow Institute of Physics and Technology
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Gao S, Li Y, Diao X, Yan S, Liu G, Liu M, Zhang Q, Zhao W, Ji B. Vacuum-assisted venous drainage in adult cardiac surgery: a propensity-matched study. Interact Cardiovasc Thorac Surg 2020; 30:236-242. [PMID: 31630172 DOI: 10.1093/icvts/ivz253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Conventional cardiopulmonary bypass with gravity drainage leads inevitably to haemodilution. Vacuum-assisted venous drainage (VAVD) utilizes negative pressure in the venous reservoir, allowing active drainage with a shortened venous line to reduce the priming volume. The goal of this study was to analyse the efficacy and safety of VAVD. METHODS Data on 19 687 patients (18 681 with gravity drainage and 1006 with VAVD) who underwent cardiac operations between 1 January 2015 and 31 January 2018 were retrospectively collected from a single centre. Propensity matching identified 1002 matched patient pairs with VAVD and gravity drainage for comparison of blood product transfusion rate, major morbidities and in-hospital mortality rates. RESULTS The blood transfusion rate of the VAVD group was lower than that of the gravity drainage group (28.1% vs 35% for red blood cells, 13% vs 18% for fresh frozen plasma and 0.1% vs 1.8% for platelets; P = 0.0009, 0.0020 and <0.0001, respectively). The mean difference (95% confidence interval) between the groups for red blood cells, fresh frozen plasma and platelets was -6.9% (-11.0% to -2.8%), -5.0% (-8.1% to -1.8%) and -1.7% (-2.5% to -0.9%), respectively. No difference was observed regarding the major morbidities of cerebrovascular accidents, acute kidney injury, hepatic failure and perioperative myocardial infarction and the in-hospital deaths between the 2 groups. CONCLUSIONS VAVD was associated with a reduction in blood product transfusions, and an increase in the risk of major morbidities and in-hospital deaths of the VAVD group was not observed.
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Affiliation(s)
- Sizhe Gao
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongnan Li
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiaolin Diao
- Department of Information Center, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shujie Yan
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mingyue Liu
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiaoni Zhang
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Information Center, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Kwak JG, Lee J, Park M, Seo YJ, Lee CH. Hemolysis During Open-Heart Surgery With Vacuum-Assisted Venous Drainage at Different Negative Pressures in Pediatric Patients Weighing Less Than 10 kilograms. World J Pediatr Congenit Heart Surg 2017; 8:161-165. [PMID: 28329457 DOI: 10.1177/2150135116681734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study examined the degree of hemolysis during vacuum-assisted venous drainage at different negative pressures to identify an adequate negative pressure that provides effective venous drainage without significant hemolysis in open-heart surgery in children weighing less than 10 kg. METHODS Patients weighing less than 10 kg who underwent surgery for ventricular septal defect or atrial septal defect from 2011 to 2014 were enrolled. We used one of four negative pressures (20, 30, 40, or 60 mm Hg) for each patient. We measured haptoglobin, plasma hemoglobin, aspartate aminotransferase, and lactate dehydrogenase levels in the patients' blood three times perioperatively and determined the potential correlation between the change in each parameter with the level of negative pressure. RESULTS Forty-six patients were enrolled in this study (mean age: 7.1 ± 7.0 months, mean body weight: 6.1 ± 1.8 kg). There were no significant differences according to the degree of negative pressure with respect to patient age, body weight, cardiopulmonary bypass (CPB) time, aorta cross-clamping time, blood flow during CPB, or lowest body temperature. All parameters that we measured reflected progression of hemolysis during CPB; however, the degree of change in the parameters did not correlate with negative pressure. CONCLUSION In pediatric patients weighing less than 10 kg, the change in the degree of hemolysis did not differ with the amount of negative pressure. We may apply negative pressures up to 60 mm Hg without increasing the risk of hemolysis, with almost same the level of hemolysis using negative pressures of 20, 30, and 40 mm Hg for effective venous drainage and an ideal operative field during open-heart surgery.
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Affiliation(s)
- Jae Gun Kwak
- 1 Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jinkwon Lee
- 2 Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi, Republic of Korea
| | - Minkyoung Park
- 2 Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi, Republic of Korea
| | - Yu-Jin Seo
- 2 Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi, Republic of Korea
| | - Chang-Ha Lee
- 2 Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi, Republic of Korea
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Cheng M, Li JQ, Wu TC, Tian WC. Short-Term Effects and Safety Analysis of Retrograde Autologous Blood Priming for Cardiopulmonary Bypass in Patients with Cardiac Valve Replacement Surgery. Cell Biochem Biophys 2016; 73:441-446. [PMID: 27352335 DOI: 10.1007/s12013-015-0661-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This randomized, double-blind study evaluated the short-term effects and safety of perioperative retrograde autologous priming (RAP) for cardiopulmonary bypass (CPB) in patients with cardiac replacement surgery to determine if this approach is a better substitute for crystal liquids priming in patients with valvular heart disease. We observed that RAP significantly decreased the actual priming volume, preserved the hematocrit and hemoglobin level during CPB to a certain degree, and decreased lactate accumulation in CPB period. Moreover, RAP lowered the volume of transfusion and dosage blood products. Thus, our results showed that RAP approach effectively improved tissue perfusion and lowered intraoperative Lac levels, by reducing the hemodilution, which safely and reliably improve the microcirculation perfusion.
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Affiliation(s)
- Ming Cheng
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Jun-Quan Li
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China.
| | - Tian-Chi Wu
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
| | - Wei-Chen Tian
- Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, 150086, Heilongjiang, People's Republic of China
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de Carvalho Filho ÉB, Marson FADL, da Costa LNG, Antunes N. Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages. Braz J Cardiovasc Surg 2015; 29:266-71. [PMID: 25140478 PMCID: PMC4389465 DOI: 10.5935/1678-9741.20140029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022] Open
Abstract
Systematic review of vacuum assisted drainage in cardiopulmonary bypass,
demonstrating its advantages and disadvantages, by case reports and evidence about
its effects on microcirculation. We conducted a systematic search on the period
1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected
articles, 26 were included in the review. Although the vacuum assisted drainage has
significant potential for complications and requires appropriate technology and
professionalism, prevailed in literature reviewed the concept that vacuum assisted
drainage contributed in reducing the rate of transfusions, hemodilutions, better
operative field, no significant increase in hemolysis, reduced complications
surgical, use of lower prime and of smaller diameter cannulas.
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Affiliation(s)
| | - Fernando Augusto de Lima Marson
- Correspondence address: Fernando Augusto de Lima Marson, Unicamp -
Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126 - Cidade
Universitária "Zeferino Vaz", Campinas, SP, Brazil - Zip code: 13083-887.
E-mail:
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Abstract
Since the early start of cardiopulmonary bypass, vascular access has been recognized as a main variable for obtaining optimal blood flow during cardiopulmonary bypass. In particular, venous drainage can limit the maximum flow as the wide, low-resistance, collapsible veins are connected with smaller stiff cannulas and tubing. Due to the introduction of long venous cannulas for minimally invasive cardiac surgery and the desire to limit hemodilution during cardiopulmonary bypass, more and more centers have started using assisted venous drainage techniques. This article gives an overview of these techniques, with their respective advantages and disadvantages.
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Zhang T, Jiang SL, Gao CQ, Luo J, Ma L, Li JC. Effect of Subzero-Balanced Ultrafiltration on Lung Gas Exchange Capacity after Cardiopulmonary Bypass in Adult Patients with Heart Valve Disease. Heart Surg Forum 2011; 14:E22-7. [DOI: 10.1532/hsf98.20101075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: This study was conducted to evaluate the effect of a new ultrafiltration techniquethe subzerobalanced ultrafiltration (SBUF)on lung gas exchange capacity after cardiopulmonary bypass (CPB) in adult patients with heart valve disease.Background: Attenuation of lung gas exchange capacity is one of the most common manifestations of an inflammatory response after CPB.Methods: Ninety-four patients who required CPB for cardiac surgery were randomized into 2 groups according to whether they received SBUF. Gas exchange capacity expressed as the oxygen index (OI), the respiratory index (RI), and the alveolar-arterial oxygen pressure difference (P(A-a)O2) were measured after intubation (T1), at the termination of CPB (T2), on admission to the intensive care unit (ICU) (T3), at postoperative hour 6 (T4), and at postoperative hour 12 (T5).Results: There were no significant differences in gas exchange capacity between the 2 groups at T1, T4, and T5. CPB produced significant changes in OI, RI, and P(A-a)O2 in the control group, whereas these changes were not significantly different in the study group. The OI in the study group was significantly higher at T2, and RI and P(A-a)O2 were significantly lower at T2 and T3. In the study group, the intubation time was shorter, and the transfusion volume within 24 hours postoperatively was less. The 2 groups were comparable with respect to the incidence of respiratory complications, length of stay in the ICU, duration of hospital stay, need for infusions of inotropic agents, and drainage volumes within 24 hours postoperatively.Conclusions: SBUF during CPB can produce an immediate improvement in lung gas exchange capacity, which may effectively minimize pulmonary dysfunction in adult patients undergoing cardiac surgery.
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Vaughan P, Fenwick N, Kumar P. Assisted venous drainage on cardiopulmonary bypass for minimally invasive aortic valve replacement: is it necessary, useful or desirable? Interact Cardiovasc Thorac Surg 2010; 10:868-71. [PMID: 20231309 DOI: 10.1510/icvts.2009.230888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Assisted venous drainage (AVD) is considered an essential component of the cardiopulmonary bypass (CPB) circuit for minimal access aortic valve replacement (mAVR). The rationale/necessity for AVD in every patient has not been fully elucidated. Data from consecutive patients undergoing isolated first-time mAVR by a single surgeon from March 2006 to October 2008 was prospectively collected. All cases were cannulated centrally. Venous drainage was by a three-stage cannula (Medtronic MC2X) via the right atrial appendage. AVD was utilised intraoperatively at the discretion of the perfusionist and/or surgeon to maintain the required flow rate. Pre- and perioperative data were compared between the two groups. Fifty-seven patients underwent mAVR. Twenty-nine did not require assistance (AVD-), 28 did (AVD+). There were no significant differences between the two groups' age, sex distribution, body mass index and risk stratification data. Patients who required AVD had significantly higher body surface areas (BSAs) [1.93 m(2) (1.56-2.46) vs. 1.79 m(2) (1.41-2.26), P=0.03] and consequent higher CPB flow required [4.62 l/min (3.74-5.90) vs. 4.29 l/min (3.38-5.42), P=0.03]. Patients who required AVD tended to have longer ischaemic times [79.5 min (48-135) vs. 69 min (47-126), P=0.06]. AVD during mAVR is not necessary in every patient. We found it to be necessary in patients with higher BSA (consequently requiring a higher flow rate on CPB).
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Affiliation(s)
- Paul Vaughan
- Department of Cardiothoracic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, Wales, S6 6NL, UK.
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Woo YJ, Seeburger J, Mohr FW. Minimally Invasive Valve Surgery. Semin Thorac Cardiovasc Surg 2007; 19:289-98. [DOI: 10.1053/j.semtcvs.2007.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2007] [Indexed: 11/11/2022]
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Latrémouille C. Canulation et retour veineux. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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