Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword

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 com...

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Published in:	European journal of cardio-thoracic surgery Vol. 33; no. 3; pp. 418 - 423
Main Authors:	Kirsch, Matthias E.W., Kostantinos, Zannis, Ali, Firas, Vermes, Emmanuelle, Bajan, Gérard, Loisance, Daniel Y.
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier Science B.V 01-03-2008 Elsevier Science
Subjects:	Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Arteries - physiology Assisted venous drainage Biological and medical sciences Cardiology. Vascular system Cardiopulmonary bypass Cardiopulmonary Bypass - methods Drainage - methods Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Erythrocyte Count Female Heart assist devices Heart Failure - physiopathology Heart Failure - surgery Heart transplantation Heart Transplantation - methods Heart-Assist Devices - standards Humans Intensive care medicine Kinetics Male Medical sciences Middle Aged Pneumology Regional Blood Flow Reoperation - adverse effects Sternum - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Young Adult Cardiopulmonary bypass Heart assist devices Heart transplantation Assisted venous drainage Heart Human Intensive cardiocirculatory care Cardiocirculatory support Patient Homotransplantation Double Drainage Orthotopic transplantation Treatment Bypass Surgery Graft Medical device Circulatory system Kinetics Cardiology Vein Pneumology
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Summary:	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 ± 0.6 l/min, p = 0.5). KAVD patients had a lower mean SvO2 and a higher desaturation index than GSD patients (69.5 ± 4.6 vs 76.1 ± 5.4 mmHg, 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.
Bibliography:	istex:5F054436CC3AE723A80BAF9CC8CF97CFA6D0AA07 ark:/67375/HXZ-BGMXHT23-L ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1010-7940 1873-734X
DOI:	10.1016/j.ejcts.2007.11.022