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Augmented venous return for minimally invasive open heart surgery with selective caval cannulation
D Jegger1, H T Tevaearai, J Horisberger
1Department of Cardiovascular Surgery, University Hospital (CHUV), Lausanne, Switzerland.
Summary
A centrifugal pump significantly improves venous drainage during minimally invasive open heart surgery, ensuring safe and optimal perfusion conditions despite smaller cannulae. This technique enhances patient outcomes in complex cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Cardiopulmonary Bypass
Background:
- Minimally invasive open heart surgery requires peripheral cardiopulmonary bypass (CPB) via percutaneous cannulae, often with limited intrathoracic access.
- Challenges arise in maintaining adequate venous return when right heart access is necessary, due to smaller vena cava diameters and cannulae.
- Impeded venous return can compromise perfusion during CPB, necessitating innovative solutions.
Purpose of the Study:
- To evaluate the efficacy of a centrifugal pump in augmenting venous drainage during minimally invasive open heart surgery.
- To assess the safety and effectiveness of peripheral CPB with enhanced venous return for complex intracardiac procedures.
Main Methods:
- A right anterior mini-thoracotomy and femoral exposure were performed, followed by heparinization.
- Femoral artery, inferior vena cava (IVC), and superior vena cava (SVC) cannulation were established for CPB initiation.
- A centrifugal pump was utilized to augment venous drainage, with subsequent cardiac arrest and vena cava snaring for intracardiac surgery.
Main Results:
- Twenty patients underwent the procedure with varying cannula sizes for femoral artery, IVC, and SVC.
- Venous drainage increased from 48.8% of theoretical flow with IVC cannulation alone to 70.7% with dual IVC/SVC cannulation (P < 0.005).
- The centrifugal pump further enhanced venous flow to 93.4% of theoretical flow (P < 0.001), achieving safe perfusion levels with minimal negative inlet pressure.
Conclusions:
- A centrifugal pump significantly improves venous drainage in minimally invasive open heart surgery, overcoming limitations of smaller vena cava and cannula diameters.
- This technique enables optimal and safe perfusion conditions, facilitating complex intracardiac procedures via minimally invasive approaches.
- The study demonstrates the clinical utility of centrifugal pumps in enhancing CPB performance for minimally invasive cardiac surgery.