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Vacuum-assisted venous return in pediatric cardiopulmonary bypass
R Berryessa1, R Wiencek, J Jacobson
1Baxter Perfusion Services and Cardiovascular Surgery Associates, Las Vegas, Nevada, USA.
Insights
Vacuum-assisted venous return (VAVR) effectively reduces priming volume and allows for smaller cannulae in pediatric cardiopulmonary bypass (CPB). This technique offers consistent venous return without adverse effects in pediatric cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Perfusion
- Medical Device Technology
Background:
- Vacuum-assisted venous return (VAVR) offers advantages in adult cardiopulmonary bypass (CPB), including enhanced venous return and reduced priming volumes.
- These benefits are particularly relevant for pediatric perfusion due to patient size and CPB circuit component proportions.
- The study addresses challenges with large priming volumes in infants, especially after a preferred oxygenator/reservoir was recalled.
Purpose of the Study:
- To evaluate the efficacy and safety of implementing vacuum-assisted venous return (VAVR) in pediatric cardiac surgery.
- To assess VAVR's impact on priming volume, venous cannula size, and venous return consistency in pediatric patients.
- To determine if VAVR can mitigate issues associated with larger priming volumes in infant perfusion.
Main Methods:
- Implementation of VAVR in pediatric perfusion following successful adult application.
- Utilization of a specific oxygenator/reservoir with a 4-liter maximum flow and approximately 1-liter priming volume.
- Systematic application of VAVR in a medium-sized pediatric caseload (over 100 CPB cases annually) since 1998.
Main Results:
- VAVR successfully decreased the priming volume required for pediatric cardiopulmonary bypass.
- The use of smaller venous cannulae was facilitated by the VAVR technique.
- Consistent venous return was achieved with no reported adverse effects in pediatric patients undergoing cardiac surgery.
Conclusions:
- Vacuum-assisted venous return (VAVR) is a beneficial and safe technique for pediatric cardiac surgery.
- VAVR helps optimize CPB circuits in children by reducing priming volume and enabling smaller cannulae.
- The consistent venous return achieved with VAVR contributes to improved outcomes in pediatric perfusion.
Abstract:
Vacuum-assisted venous return (VAVR) has been reported to offer benefits for adults undergoing cardiopulmonary bypass (CPB), such as improved venous return, lowering priming volume (by eliminating the need to prime the venous line), and the use of smaller venous cannulae. All these benefits would be of particular value in pediatric perfusion because of the unique challenges of these smaller patients and the relatively large components of the CPB circuit. We have been using VAVR in children since the early summer of 1998 after we became comfortable with the technique and convinced of its efficacy in adults. Ours is a medium-sized pediatric caseload of slightly more than 100 CPB cases per year. With that caseload, it is most effective for us to minimize the inventory of different sizes of disposables used. We have opted for an oxygenator/reservoir that has a maximum flow of 4 liters with a priming volume of about 1 liter. We have been unhappy with the large prime volume in infants and earlier, in 1997-1998, were using a smaller prime oxygenator/reservoir until it was recalled. Faced again with a larger priming volume in the infants, we decided to try vacuum to decrease hemodilution and to evaluate other possible benefits. Through the use of VAVR, we have been able to decrease our priming volume, use smaller venous cannulae, and have more consistent return while experiencing no adverse effects of VAVR in our pediatric cardiac surgery patients.