|
Sign In to gain access to subscriptions and/or personal tools.
|
Total extrathoracic cardiopulmonary support with kinetic assisted venous drainage: experience in 50 patients
John M Toomasian
Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
J Patrick McCarthy
Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
Extrathoracic cardiopulmonary bypass is used in special situations when normal access to the right atrium and aorta is difficult or not practicable. Femero-femoral bypass using gravity drainage is effective for partial cardiopulmonary support, but cannot usually provide adequate venous drainage for full circulatory support. Kinetic assisted venous drainage (KAVD) is the process of applying a controlled suction on the venous line with a kinetic pump to augment venous drainage.
KAVD has been used in 50 patients where femero-femoral bypass was selected as the mode of circulatory support. These cases included: redo-operations with significant sternal adhesions (15), minimally invasive port-access cardiac surgery (12), haemodynamic instability (10), left thoracotomy (10), and others (3). In 11 cases, a second venous catheter was added because of protocol. No appreciable increase in venous return occurred with the addition of a second drainage catheter. All patients were adequately supported and a 20-40% increase in venous return was observed once KAVD was implemented.
A wide variety of different venous catheters have been used with KAVD. Optimal use relates to having a thin-walled catheter with multiple side holes, not exerting an excessive negative pressure with the pump and positioning the catheter tip at the right atrio-superior vena cava junction. Optimal catheter tip placement is enhanced by using transoesophageal echocardiography. KAVD is best regulated by measuring the siphon generated by the kinetic pump. When the inlet pressure is properly monitored and controlled, KAVD can provide adequate venous drainage to completely support the circulation on a single femoral venous cannula.
Perfusion, Vol. 13, No. 2,
137-143 (1998)
DOI: 10.1177/026765919801300209
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
L. K. von Segesser, E. Ferrari, D. Delay, O. Maunz, J. Horisberger, and P. Tozzi
Routine use of self-expanding venous cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive cases
Eur. J. Cardiothorac. Surg.,
September 1, 2008;
34(3):
635 - 640.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E.W. Kirsch, Z. Kostantinos, F. Ali, E. Vermes, G. Bajan, and D. Y. Loisance
Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword
Eur. J. Cardiothorac. Surg.,
March 1, 2008;
33(3):
418 - 423.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Hammon
Extracorporeal Circulation: Perfusion System
Card. Surg. Adult,
January 1, 2008;
3(2008):
350 - 370.
[Full Text]
|
|
|
|
|
|
|
W. Riley, D. FitzGerald, and L. Cohn
Single, percutaneous, femoral venous cannulation for cardiopulmonary bypass
Perfusion,
May 1, 2007;
22(3):
211 - 215.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M L Field, B Al-Alao, N Mediratta, and A Sosnowski
Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes.
Postgrad. Med. J.,
May 1, 2006;
82(967):
323 - 331.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Hessel II and L. H. Edmunds Jr.
Extracorporeal Circulation: Perfusion Systems
Card. Surg. Adult,
January 1, 2003;
2(2003):
317 - 338.
[Full Text]
|
|
|
|
|
|
|
Y Tamari, K Lee-Sensiba, J Beck, R Chan, M Salogub, M Hall, T Lee, R Ganju, and L Mongero
A new top-loading venous bag provides vacuum-assisted venous drainage
Perfusion,
September 1, 2002;
17(5):
383 - 390.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Y.-m. Ni, B. Leskosek, L.-p. Shi, Y.-l. Chen, L.-f. Qian, R.-y. Li, Z.-l. Tu, and L. K. von Segesser
Optimization of venous return tubing diameter for cardiopulmonary bypass
Eur. J. Cardiothorac. Surg.,
September 1, 2001;
20(3):
614 - 620.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Cirri, L. Negri, M. Babbini, G. Latis, B. Khlat, G. Tarelli, P. Panisi, E. Mazzaro, A. Bellisario, B. Borghetti, et al.
Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques
Perfusion,
July 1, 2001;
16(4):
313 - 318.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. W. Ojito, R. L. Hannan, K. Miyaji, J. A. White, T. W. McConaghey, J. P. Jacobs, and R. P. Burke
Assisted venous drainage cardiopulmonary bypass in congenital heart surgery
Ann. Thorac. Surg.,
April 1, 2001;
71(4):
1267 - 1271.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Jegger, H. T. Tevaearai, J. Horisberger, X. M. Mueller, Y. Boone, N. Pierrel, I. Seigneul, and L. K. von Segesser
Augmented venous return for minimally invasive open heart surgery with selective caval cannulation
Eur. J. Cardiothorac. Surg.,
September 1, 1999;
16(3):
312 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kurusz, D. J Deyo, A. D Sholar, W. Tao, and J. B Zwischenberger
Laboratory testing of femoral venous cannulae: effect of size, position and negative pressure on flow
Perfusion,
September 1, 1999;
14(5):
379 - 387.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. M Toomasian
Cardiopulmonary bypass for less invasive procedures
Perfusion,
July 1, 1999;
14(4):
279 - 286.
[PDF]
|
|
|
|
|
