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Eur J Cardiothorac Surg 2007;31:1044-1051. doi:10.1016/j.ejcts.2007.01.066
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Review

Systemic venous drainage: can we help Newton?

Alder Hey Royal Children Hospital, Eaton Road, Liverpool, L12 2AP, England, UK

Received 29 November 2006; received in revised form 23 January 2007; accepted 31 January 2007.

^_* Corresponding author. Tel.: +44 151 2525713; fax: +44 151 2525643. (Email: Antonio.Corno{at}rlc.nhs.uk).

In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple ‘Law of universal gravitation’ by Isaac Newton.

Key Words: Anomalous venous connection • Assist venous return • Cardiopulmonary bypass • Pump flow • Venous cannulas • Venous drainage

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