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Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience
Erkan Kuralay1, Cengiz Bolcal, Faruk Cingoz
1Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey. ekural@gata.edu.tr
Insights
Establishing cardiopulmonary bypass before sternal reentry significantly reduces cardiac injury and bleeding during reoperation. This improved safety profile enhances patient outcomes in complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Anesthesiology
Background:
- Median sternotomy reoperation carries a high risk of cardiac injury due to adhesions.
- Current sternal division is often a blind procedure, increasing operative risks.
Purpose of the Study:
- To evaluate the safety and efficacy of establishing cardiopulmonary bypass before sternal reentry in reoperative cardiac surgery.
- To compare outcomes between pre-emptive and post-sternotomy cardiopulmonary bypass.
Main Methods:
- A randomized controlled trial involving 200 patients undergoing cardiac reoperation.
- Group 1 (n=100): Cardiopulmonary bypass initiated via femoral vessels before sternal reentry.
- Group 2 (n=100): Cardiopulmonary bypass initiated after sternal reentry.
Main Results:
- Six severe cardiac injuries occurred in Group 2 versus none in Group 1.
- Group 1 demonstrated significantly reduced chest drainage, blood transfusion, and ICU/hospital stay.
- While cardiopulmonary bypass time was longer in Group 1, overall operation time was reduced.
Conclusions:
- Pre-emptive cardiopulmonary bypass via femoral cannulation before resternotomy significantly mitigates cardiac injury and hemorrhage risk.
- This technique ensures safe sternal reopening and improves patient recovery metrics.
- The benefits of reduced complications outweigh the increased cardiopulmonary bypass time.
Background:
Division of the sternum is primarily a blind procedure in reoperation and carries an increased risk of injury for major cardiac structures in the presence of adhesions between the posterior table and the heart.
Methods:
Two hundred patients were randomly divided into two groups. Cardiopulmonary bypass was established through the femoral artery and vein in group 1 (n = 100) patients before sternal reentry. Carpentier dual-stage femoral venous return cannula was used in all group 1 patients. Cardiopulmonary bypass was performed after sternal reentry in group 2 (n = 100) patients.
Results:
Six severe cardiac injuries developed in group 2. Cardiopulmonary bypass time was 93 +/- 9 minutes in group 1 and 71 +/- 11 minutes in group 2 (p = 0.011), and the operation time was 155 +/- 23 minutes in group 1 and 185 +/- 32 minutes in group 2 (p = 0.024). Inotropic therapy was required in 52 patients in group 1 and 76 patients in group 2 (p = 0.032). Average chest drainage was 450 +/- 135 mL in group 1 and 850 +/- 250 mL in group 2 (p < 0.001). Average fresh whole blood transfusion was 3.3 +/- 1.2 U in group 1 and 5.8 +/- 0.9 U in group 2 (p = 0.033). Average intensive care unit stay was 2.2 +/- 1.3 days in group 1 and 4.5 +/- 2.3 days in group 2 (p = 0.025). Average hospital stay was 7.3 +/- 2.4 days in group 1 and 9.1 +/- 3.1 days for group 2 (p = 0.011).
Conclusions:
Cardiopulmonary bypass by bicaval Carpentier femoral venous cannula before resternotomy not only allows adequate cardiopulmonary bypass flow but also significantly reduces the risk of cardiac injury and catastrophic hemorrhage and allows safe reopening. Although this procedure increases cardiopulmonary bypass time, the operation time, bleeding, and blood transfusion requirement are significantly reduced.
