Document Detail


A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery.
MedLine Citation:
PMID:  16476552     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Transthoracic echocardiography (TTE) has been used clinically to disobstruct venous drainage cannula and to optimise placement of venous cannulae in the vena cava but it has never been used to evaluate performance capabilities. Also, little progress has been made in venous cannula design in order to optimise venous return to the heart lung machine. We designed a self-expandable Smartcanula (SC) and analysed its performance capability using echocardiography. METHODS: An epicardial echocardiography probe was placed over the SC or control cannula (CTRL) and a Doppler image was obtained. Mean (V(m)) and maximum (V(max)) velocities, flow and diameter were obtained. Also, pressure drop (DeltaP(CPB)) was obtained between the central venous pressure and inlet to venous reservoir. LDH and Free Hb were also compared in 30 patients. Comparison was made between the two groups using the student's t-test with statistical significance established when p<0.05. RESULTS: Age for the SC and CC groups were 61.6+/-17.6 years and 64.6+/-13.1 years, respectively. Weight was 70.3+/-11.6 kg and 72.8+/-14.4 kg, respectively. BSA was 1.80+/-0.2 m(2) and 1.82+/-0.2 m(2), respectively. CPB times were 114+/-53 min and 108+/-44 min, respectively. Cross-clamp time was 59+/-15 min and 76+/-29 min, respectively (p=NS). Free-Hb was 568+/-142 U/l versus 549+/-271 U/l post-CPB for the SC and CC, respectively (p=NS). LDH was 335+/-73 mg/l versus 354+/-116 mg/l for the SC and CC, respectively (p=NS). V(m) was 89+/-10 cm/s (SC) versus 63+/-3 cm/s (CC), V(max) was 139+/-23 cm/s (SC) versus 93+/-11 cm/s (CC) (both p<0.01). DeltaP(CPB) was 30+/-10 mmHg (SC) versus 43+/-13 mmHg (CC) (p<0.05). A Bland-Altman test showed good agreement between the two devices used concerning flow rate calculations between CPB and TTE (bias 300 ml+/-700 ml standard deviation). CONCLUSIONS: This novel Smartcanula design, due to its self-expanding principle, provides superior flow characteristics compared to classic two stage venous cannula used for adult CPB surgery. No detrimental effects were observed concerning blood damage. Echocardiography was effective in analysing venous cannula performance and velocity patterns.
Authors:
David Jegger; Pierre-Guy Chassot; Marc-Andre Bernath; Judith Horisberger; Philippe Gersbach; Piergiorgio Tozzi; Dominique Delay; Ludwig K von Segesser
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2006-02-14
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  29     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-20     Completed Date:  2006-06-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  525-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. David.Jegger@chuv.hospvd.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anthropometry
Cardiopulmonary Bypass*
Catheterization, Central Venous / instrumentation,  methods*
Coronary Artery Bypass*
Echocardiography, Doppler / methods
Equipment Design
Female
Hemoglobins / metabolism
Humans
Intraoperative Care / methods*
Lactate Dehydrogenases / blood
Male
Middle Aged
Vena Cava, Inferior / ultrasonography
Chemical
Reg. No./Substance:
0/Hemoglobins; EC 1.1.-/Lactate Dehydrogenases

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


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