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

Department of Cardio-Vascular Surgery, CHUV, Lausanne, Switzerland

Received 27 February 2008; received in revised form 1 May 2008; accepted 20 May 2008.

^_* Corresponding author. Address: Department of Cardio-Vascular Surgery, CHUV, CCV, BH 10-275, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel.: +41 21 314 22 79; fax: +41 21 314 22 78. (Email: ludwig.von-segesser{at}chuv.ch). (URL: http://www.cardiovasc.net/).

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 ± 0.6 l/min (=114% of target) in the entire study population (n = 76) as compared to the calculated, theoretical pump flow of 4.4 ± 0.5 l/min (p < 0.0001). For the femoral cannulation sub-group (n = 35) pump flow achieved by gravity drainage alone accounted for 4.9 ± 0.6 l/min (=114% of target) as compared to the calculated theoretical pump flow of 4.3 ± 0.4 l/min (p < 0.0001). The corresponding numbers for trans-subclavian cannulation (n = 7) are 5.2 ± 0.5 l/min (111%) for the pump flow achieved by gravity drainage as compared to the theoretical target flow of 4.7 ± 0.4 l/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 ± 0.7 l/min (=116% of target) as compared to the calculated theoretical flow of 4.4 ± 0.6 l/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.

Key Words: Cannulas • Self-expanding cannulas • Smart cannulation • Cardiopulmonary bypass • Perfusion • Heart lung machine • Reoperation • Open-heart surgery