In vitro assessment of the vacuum-assisted venous drainage (VAVD) system: risks and benefits

Abstract

The vacuum-assisted venous drainage (VAVD) technique has been introduced with the utilization of small-bore venous cannulae to facilitate minimally invasive cardiac surgery and it has found widespread use for traditional surgical approaches. Although this technique was devised to increase venous return, it may cause a reduction of blood flow through a negative pressure effect on the raceway tubing.

In this study, the potential of this system to increase the venous drainage was evaluated in vitro together with the measurements of delivered blood flow. The VAVD has been tested in association with normal gravitational drainage or as a substitute for gravitational drainage. The flow was calculated by multiplying the pump rate by the stroke volume and it was simultaneously measured by a magnetic flowmeter. A steady state maximal flow was defined as the flow that could maintain a constant level of fluid in the graduated canister used to act as the patient.

Based on our results, the VAVD can increase venous drainage by as much as 50% above baseline levels. However, delivered blood flow may be overestimated, particularly when negative pressure values >60 mmHg are employed. A 100 mmHg negative pressure may produce an overestimate of blood flow as great as 54% of the measured flow.

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References

Toomasian JM , Peters WS , Siegel LC , Stevens JH. Extracorporeal circulation for port-access cardiac surgery . Perfusion 1997; 12: 83-91 .

Münster K , Andersen U , Mikkelsen J , Pettersson G. Vacuum assisted venous drainage (VAVD) . Perfusion 1999; 14: 419-423 .

Galletti PM , Brecher GA. Connection of the vascular system with an extracorporeal circuit. In Galletti PM , Brecher GA eds. Heart lung bypass: principles and techniques of extracorporeal circulation. New York, NY: Grune and Stratton , 1962: 171-178.

Gooris T , Van Vaerenbergh G , Coddens J , Bouchez S , Vanermen H. Perfusion techniques for port-access surgery . Perfusion 1998; 13: 243-247 .

Windahl S , Breum L , Andersen LW. Vacuum assisted venous drainage causes reduced pump flow (abstract) . 5es journées du Colle`ge Français de Perfusion 2000; 61-61 .

Cirri S , Negri L , Babbini M , et al. Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques . Perfusion 2001; 16: 313-318 .

McLaggan L , Willcox TW , Mills BP , Mann N , West T. Arterial line emboli in two current generation cardiopulmonary bypass circuits: effects of venous air and pulsatile flow . Heart Surg Forum 2003; 6: 206-206 .

McCusker K , Vijay V , DeBois W , Helm R , Sisto D. MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery . Perfusion 2001; 16: 447-452 .

Humphries K , Sistino JJ. Laboratory evaluation of the pressure flow characteristics of venous cannulas during vacuum-assisted venous drainage . J Extra Corpor Technol 2002; 34: 111-114 .