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

Service de Chirurgie Thoracique et Cardiovasculaire, AP-HP, Hôpital Henri Mondor, Créteil, France

Received 23 May 2007; received in revised form 31 August 2007; accepted 26 November 2007.

^_* Corresponding author. Address: 51 Avenue du Maréchal de Lattre de Tassigny, 94 000 Créteil Cédex, France. Tel.: +33 1 49 81 21 72; fax: + 33 149 81 21 52. (Email: matthias.kirsch{at}hmn.aphp.fr).

Background: Heart transplantation in patients supported with ventricular assist devices (VADs) entails a high risk of injury at resternotomy. Prior femorofemoral bypass is the preferred approach in these patients, but poor venous drainage may restrict arterial flow rate. Patients and methods: We compared bypass parameters, transfusion requirements and postoperative outcome in 33 consecutive patients (40.4 ± 12.2 years old, 28 men) assisted with the Thoratec^® paracorporeal VAD (mean duration, 3.0 ± 2.96 months) undergoing transplantation using either gravity siphon drainage (GSD, n = 16) or kinetic assisted venous drainage (KAVD, n = 17). Results: Cannulation technique, perfusion pressure, temperature and duration were similar between groups. There were no significant differences in arterial re-infusion flow rates (GSD, 3.6 ± 0.7 vs KAVD, 3.8 ± 0.6 l/min, p = 0.5). KAVD patients had a lower mean S_vO₂ and a higher desaturation index than GSD patients (69.5 ± 4.6 vs 76.1 ± 5.4 mmHg, p = 0.004; and 0.63 ± 0.23 vs 0.25 ± 0.63, p = 0.0001, respectively). Perioperative requirements in fresh frozen plasma and platelet transfusions were significantly higher in KAVD patients. However, there were no differences in postoperative patient outcome. Conclusion: Perceived benefits on venous return associated with KAVD do not necessarily translate into improved arterial re-infusion flow rates and should be weighed against the hazards of increased venous air aspiration and blood product requirements.

Key Words: Cardiopulmonary bypass • Assisted venous drainage • Heart assist devices • Heart transplantation