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Ann Thorac Surg 1977;24:566-573
© 1977 The Society of Thoracic Surgeons

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Articles

Is a Left Ventricular Vent Necessary During Cardiopulmonary Bypass?

Division of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio and the Audie L. Murphy Veterans Administration Hospital, San Antonio, TX.

^* Address reprint requests to Dr. Arom, Division of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284

This study evaluated the coronary flow and the internal diameter, pressure, and metabolism of the left ventricle using four different cardiopulmonary bypass techniques. Conditioned dogs underwent a 30-minute stabilizing period on cardiopulmonary bypass with a beating, empty heart (normothermia and a flow of 80 ml/kg/min). They were then fibrillated and subjected to four experiments: Group A (7 dogs)—left ventricular vent, caval tapes open; group B (7 dogs)—left ventricular vent, caval tapes closed; group C (7 dogs)—no vent, caval tapes open; group D (4 dogs)—no vent, caval tapes closed.

There was no major difference in any of these variables among Groups A and B (both ventricles vented). Group D (no vent, tapes closed) had significantly increased wall tension, decreased coronary flow, decreased subendocardial flow, and ischemia. In contrast, Group C dogs (no vent, tapes open) had only a slight increase in left ventricular diameter and pressure, with no change from Group A and B dogs in coronary flow, lactate extraction, hydrogen ion production, or potassium difference. Therefore, venting the fibrillating ventricle, either with or without snaring of the caval tapes, is probably the best method to use during the distal anastomosis in a coronary artery bypass operation. However, if a vent is not used, the caval tapes should be left open to allow complete diversion of the venous blood and decompression of the left ventricle.

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