Video-assisted right atrial surgery with a single two-stage femoral venous cannula

In the present paper, we report our experience with a single two-stage femoral venous cannula, ideated to drain simultaneously both the superior and the inferior vena cava during minimally invasive cardiac surgery. This cannula has been used in 79 patients (mean age 66.2+/-11.3 years; mean body surface area 1.9+/-0.2 m2) who underwent limited access mitral and tricuspid valve surgery at our institution. In our experience, this cannula permits to obtain a safe venous drainage (mean arterial flow 4.7+/-0.6 l/min, 104+/-13.3% of the theoretical flow) and it allows for a correct functioning of the pump even when the right atrium is opened. In redo cases (17 patients) the procedure was conducted without snaring the caval veins. In all cases, insertion and positioning of the venous cannula was easily obtained and no patients required a conversion to an alternative perfusion strategy. In conclusion, during minimally invasive procedures requiring opening the right atrium, venous return can be safely accomplished with this two-stage femoral venous cannula. The use of this cannula permits the avoidance of the risk associated with the insertion of a second venous cannula and, in so doing, significantly simplifies the procedure.