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Ann Thorac Surg 2001;71:1271-1272
© 2001 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Suite 8527, Philadelphia, PA 19104-4399, USA
e-mail: gaynor{at}email.chop.edu
The use of cardiopulmonary bypass for the repair of congenital heart defects often exposes infants to extremes of hemodilution and hypothermia leading to significant morbidity. Modifications of the bypass circuit which decrease priming volume and improve venous drainage are of obvious importance to minimize the associated morbidity. A variety of systems have been described for assisted venous drainage during cardiopulmonary bypass using either a pump in the venous line or wall vacuum to augment venous return. Use of assisted venous drainage has two major goals: (1) reduction of venous and arterial line size and length, thus reducing priming volume; and (2) improved venous drainage to provide optimal visualization of the operative field. It is not known if the use of assisted venous drainage will result in an improved outcome, compared to traditional gravity drainage and if so, which technique of venous drainage provides the greatest safety and efficacy. In this report from Miami Children’s Hospital, the authors describe and evaluate a new assisted venous drainage system, "venous pull", using a single centrifugal pump to augment venous drainage and provide arterial flow. The authors demonstrate that their technique of assisted venous drainage is safe and results in a decrease in the priming volume of the circuit, as well as allows use of smaller venous cannulae, which may improve visualization of the operative field.
Because of the study design, however, it is impossible to determine if this assisted drainage technique provides a clear benefit over standard gravity drainage techniques. The study is retrospective. Gravity drainage was utilized in the first 200 patients and assisted venous drainage in the second 200 patients. There was no difference between groups in mortality or duration of hospitalization. Cardiac complications defined as arrhythmia, pericardial effusion, and cardiac failure were less common in the assisted drainage group. Postoperative bleeding was less in the assist group, but no data are provided concerning blood utilization, postoperative hematocrit, or reoperation for bleeding. These differences, while important, are likely due to increasing experience of the surgical and ICU teams, rather than the venous drainage technique. There was no difference in pulmonary complications between groups, but the authors do not provide data concerning pulmonary function, duration of mechanical ventilation, or ICU stay which are important markers following cardiopulmonary bypass.
Introduction of new bypass techniques and circuit modifications frequently increases the complexity of the circuit and thus the potential for complications. Nevertheless, the findings of this study and others, while not conclusive, suggest that assisted venous drainage techniques are safe and will be important adjuncts for infant cardiopulmonary bypass in the future. Careful prospective evaluation of the various methods is necessary.
Related Article
Ann. Thorac. Surg. 2001 71: 1267-1271.
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