Clinical Experience With New Wall-less Cannulas
Ludwig K. von Segesser1, Berdajs Denis2, Enrico Ferrari3, Ludwig Mueller4, Maximilian Halbe5, Francesco Maisano5.
1CHUV, Lausanne, Switzerland, 2University Hospital, Basel, Switzerland, 3CardioCentro Ticino, Lugano, Switzerland, 4University Hospital, Innsbruck, Austria, 5University Hospital, Zurich, Switzerland.
OBJECTIVE: Inadequate venous drainage during minimally invasive cardiac surgery (MICS) is a major challenge and cannot always be solved with increased vacuum levels or centrifugal pump speed respectively. The present study was designed to assess the benefit of virtually wall-less venous cannulas designed for remote venous cannulation in combination with augmented venous drainage.
METHODS: Trans-femoral venous cannulation with virtually wall-less cannulas designed for augmented venous drainage (3/8” 24F 530-630 mm ST) was studied in 10 consecutive patients (59+10 years, 8 males, 2 females) undergoing MICS for mitral (6), aortic (3) and other (4) procedures (combinations possible). Prior to trans-femoral insertion of wall-less venous cannulas, a guide wire was positioned in the superior vena cava under echocardiographic control, a wall-less cannula was then fed over the wire, and connected to a minimal extra-corporeal system in combination with a sealed hard shell venous reservoir. Vacuum assist was used in order to reach a target flow of 2.4 l/min m2 with augmented venous drainage at less than -80 mmHg.
RESULTS: Wall-less venous cannulas measuring either 630 mm (n=8) in length or 530 mm (n=2) was implanted successfully in all patients. For a body size of 173+11 cm and a body weight of 78+26 kg, the calculated body surface area was 1.94+0.32 m2. As a result, the estimated target flow was 4.66+0.78 l/min, whereas the achieved flow accounted for 4.98+0.69 l/min (107% of target) at a vacuum level of 21.3+16.4 mmHg. Excellent exposure and a “dry” intra-cardiac surgical field resulted.
CONCLUSIONS: The performance of virtually wall-less venous cannulas designed for augmented venous drainage tested here in the clinical setting provided excellent flows at minimal vacuum levels and thus confirmed the performance increase over traditional thin wall cannulas previously demonstrated in vitro and in vivo. Superior results can be expected for routine use.
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