Document Detail


Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword.
MedLine Citation:
PMID:  18162404     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Heart transplantation in patients supported with ventricular assist devices (VADs) entails a high risk of injury at resternotomy. Prior femorofemoral bypass is the preferred approach in these patients, but poor venous drainage may restrict arterial flow rate. PATIENTS AND METHODS: We compared bypass parameters, transfusion requirements and postoperative outcome in 33 consecutive patients (40.4+/-12.2 years old, 28 men) assisted with the Thoratec paracorporeal VAD (mean duration, 3.0+/-2.96 months) undergoing transplantation using either gravity siphon drainage (GSD, n=16) or kinetic assisted venous drainage (KAVD, n=17). RESULTS: Cannulation technique, perfusion pressure, temperature and duration were similar between groups. There were no significant differences in arterial re-infusion flow rates (GSD, 3.6+/-0.7 vs KAVD, 3.8+/-0.6l/min, p=0.5). KAVD patients had a lower mean S(v)O(2) and a higher desaturation index than GSD patients (69.5+/-4.6 vs 76.1+/-5.4mmHg, p=0.004; and 0.63+/-0.23 vs 0.25+/-0.63, p=0.0001, respectively). Perioperative requirements in fresh frozen plasma and platelet transfusions were significantly higher in KAVD patients. However, there were no differences in postoperative patient outcome. CONCLUSION: Perceived benefits on venous return associated with KAVD do not necessarily translate into improved arterial re-infusion flow rates and should be weighed against the hazards of increased venous air aspiration and blood product requirements.
Authors:
Matthias E W Kirsch; Zannis Kostantinos; Firas Ali; Emmanuelle Vermes; Gérard Bajan; Daniel Y Loisance
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Publication Detail:
Type:  Journal Article     Date:  2007-12-26
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  33     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-19     Completed Date:  2009-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  418-23     Citation Subset:  IM    
Affiliation:
Service de Chirurgie Thoracique et Cardiovasculaire, AP-HP, Hôpital Henri Mondor, Créteil, France. matthias.kirsch@hmn.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Arteries / physiology
Cardiopulmonary Bypass / methods*
Drainage / methods
Erythrocyte Count
Female
Heart Failure / physiopathology,  surgery*
Heart Transplantation / methods*
Heart-Assist Devices / standards*
Humans
Kinetics
Male
Middle Aged
Regional Blood Flow
Reoperation / adverse effects
Sternum / surgery
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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