Skip to main content

Advertisement

SpringerLink
Log in

Herzentlastung mittels EKZ vor der Resternotomie

Cardiac decompression with cardio-pulmonary bypass prior to resternotomy

  • ORIGINALARBEIT
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Ziel

Verhinderung katastrophaler Blutungen anlässlich einer Resternotomie durch vorangehende kardiale Dekompression mittels EKZ, peripherer Smart-Kanülierung und schwerkraftgetriebener Drainage.

Methode

Prospektive Untersuchung von trans-femoraler venöser Kanülierung der kavalen Achse mittels smartcanula® und kardiale Dekompression durch EKZ vor der Resternotomie bei 20 konsekutiven Patienten.

Resultate

Die smarte venöse periphere Kanülierung war bei allen 20 Patienten erfolgreich. Folgende Operationen wurden durchgeführt: A) Herzklappenreoperation in 9/20 Patienten (45%), B) Reoperation der Aorta aszendens in 5/20 (25%), C) Reoperation von kongenitalen Vitien in 4/20 (20%) und D) andere Reoperationen in 2/20 (10%). Für die gesamte Serie betrug der Maschinen-Sollfluss 4,2±0,3 l/min wogegen der Blutfluss vor der Resternotomie 4,3±0,6 l/min (NS) ereichte. Bei Patienten mit einfacher venöser Kanülierung (A, B, und D: 16/20), wurde für einen Sollfluss von 4,3+0,3 l/min ein Blutfluss von 4,6±0,5 l/min (=106%) vor vs. 4,6+0,5 l/min (=106%) nach Resternotomie gemessen (NS). Bei Patienten welche eine doppelte venöse Kanülierung (Gruppe C=kongenitale Vitien) und einen Sollfluss von 4,0+0,1 l/min benötigten, wurde der Thorax nach einfacher femoraler venöser Kanülierung bei einem gemessenen Fluss von 3,4±0,7 l/min (86%) eröffnet. Mit einer zweiten Kanüle stieg dieser auf 4,1 l/min an (102%: NS). Für Patienten mit 36F und 63 cm langen smartcanula® (n=10) wurde ein Sollfluss von 4,4±0,2 l/min errechnet und vor der Sternotmie ein Blutfluss von 4,9±0,2 l/min (111%; p<0,05) gemessen, während für kürzere 36F Kanülen (< 53 cm) ein Sollfluss von 4,0±0,1 l/min errechnet und ein Blutfluss von 4,0+0,2 l/min (100%: NS) gemessen wurde.

Schlussfolgerung

Die smarte femorale venöse Kanülierung erlaubt es vollen Blutfluss zu fahren und das Herz effizient zu dekomprimieren bevor das Sternum wieder eröffnet wird. Eine längere smartcannula® drainiert besser und fördert mehr Blut.

Abstract

Objective

Avoid catastrophic haemorrhage during sternal re-entry by prior cardiac decompression using CPB with gravity drivensmart venous drainage.

Methods

Prospective study of trans-femoral cannulation of the inferior vena cava, the right atrium and/or superior vena cava respectively with the smartcanula® and cardiac decompression with CPB prior to sternal re-entry in 20 consecutive cardiac reoperations.

Results

Smart venous cannulation was successful in 20/20 patients who underwent the following operations: A) 9/20 patients (45%) a redo valve procedure, B) 5/20 (25%) a redo aortic procedure, C) 4/20 (20%) a redo congenital repair, and D) 2/20 (10%) other re-operations. For the entire series, target blood flow was 4.2±0.3 l/min whereas the flow achieved prior to sternal re-entry accounted for 4.3±0.6 l/min (NS). For patients requiring single venous cannulation (A, B, and D: 16/20), target flow was 4.3+0.3 l/min and achieved flow prior to sternal re-entry 4.6±0.5 l/min (=106%) vs. 4.6+0.5 l/min (=106%) after sternal re-entry (NS). For patients requiring dual venous cannulation (group C=congenitals) and a target pump flow of 4+0.1 l/min, the chest was opened after single remote venous cannulation at flow of 3.4±0.7 l/min (86%) which increased to 4.1 l/min with a second cannula (102%: NS). For 36F and 63 cm long smartcanula® (n=10) target flow was 4.4±0.2 l/min and achieved flow accounted for 4.9±0.2 l/min (111%; p<0.05), whereas for shorter 36F cannula (< 53 cm) target flow was 4.0±0.1 l/ min and achieved flow accounted for 4.0+0.2 l/min (100%: NS).

Conclusion

Smart femoral cannulation allows for full flow prior to sternal reentry and efficient cardiac decompression. Higher blood flows can be achieved with longer smartcannulas®.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. von Segesser LK, Jornod N, Faidutti B (1987) Repeat sternotomy after reconstruction of the pericardial sac with glutaraldehyde preserved equine pericardium. J Thorac Cardiovasc Surg 93:616–619

    PubMed  CAS  Google Scholar 

  2. Yamauchi T, Miyamoto Y, Ichikawa H, Takano H, Sawa Y (2006) Large vessel-sternum adhesion after cardiac surgery; a risk factor analysis. Surg Today 36:596–601

    Article  PubMed  Google Scholar 

  3. Dobell AR, Jain AK (1984) Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg 37:273–278

    Article  PubMed  CAS  Google Scholar 

  4. Loop FD (1984) Catastrophic haemorrhage during sternal reentry. Ann Thorac Surg 37: 271–272

    Article  PubMed  CAS  Google Scholar 

  5. Spain K (2004) Use of deep hypothermic circulatory arrest following ventricular laceration: a case report. AANA J 72:193–195

    PubMed  Google Scholar 

  6. Cooley DA, Lopez RM, Absi TS (2000) Apicoaortic conduit for left ventricular outflow tract obstruction: revisited. Ann Thorac Surg 69:1511–1514

    Article  PubMed  CAS  Google Scholar 

  7. Byrne JG, Karavas AN, Adams DH, Aklog L, Aranki SF, Filsoufi F, Cohn LH (2001) The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia, and avoidance of LIMA-LAD graft. J Heart Valve Dis 10:584–590

    PubMed  CAS  Google Scholar 

  8. Grunewald RP (1985) A technique for direct-vision sternal reentry. Ann Thorac Surg 40:521–522

    Article  Google Scholar 

  9. Athanasiou T, Stanbridge RD, Kumar P, Cherian A (2002) Video assisted resternotomy in high-risk redo operations – the St Mary's experience. Eur J Cardio-thorac Surg 21:932–934

    Article  Google Scholar 

  10. Mejia R, Saxena P, Tam RK (2005) Hydrodissection in redo sternotomy. Ann Thorac Surg 79:363–364

    Article  PubMed  Google Scholar 

  11. Maselli D, Santise G, Montalto A, Musumeci F (2005) Endovascular aortic clamping for pseudoaneurysms of the aortic root with aortic regurgitation. Ann Thorac Surg 80:1303–1308

    Article  PubMed  Google Scholar 

  12. Gasparovic H, Byrne JG (2005) The use of a femoral arterial cannula for effective dilatation for percutaneous femoral venous cannulation. J Card Surg 20:68–69

    Article  PubMed  Google Scholar 

  13. Kuralay E, Bolcal C, Cingoz F,Gunay C, Yildirim V, Kelic S, Ozal E, Demirkilic U, Arslan M, Tatar H (2004) Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience. Ann Thorac Surg 77:977–982

    Article  PubMed  Google Scholar 

  14. Merin O, Silbermann S, Brauner R, Munk Y, Shapira N, Falkowski G, Dzigivker I, Bitran D (1998) Femorofemoral bypass for repeat open heart surgery. Perfusion 13:455–459

    PubMed  CAS  Google Scholar 

  15. von Segesser LK (1999) Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist. Ann Thorac Surg 68:672–677

    Article  PubMed  CAS  Google Scholar 

  16. Mueller XM, Mallabiabarrena I, Mucciolo G, von Segesser LK (2002) Optimized venous return with a self-expanding cannula: from computational fluid dynamics to clinical application. Interactive CardioVascular and Thoracic Surgery 1:23–27

    Article  PubMed  Google Scholar 

  17. von Segesser LK, Jegger D, Mucciolo G, Tozzi P, Mucciolo A, Delay D, Mallabiabarrena I, Horisberger J (2005) The Smart Canula: A new tool for remote access in limited access cardiac surgery. The Heart Surgery Forum 8:E241–E245

    Article  PubMed  Google Scholar 

  18. von Segesser LK, Tozzi P, Ferrari ER, Huber C, Delay D, Jegger D, Horisberger J (2006) Small access (30F) clinical central venous cannulation: is it adequate? Interactive CardioVascular and Thoracic Surgery, pp 540–543

  19. von Segesser LK (2006) Peripheral cannulation for cardiopulmonary bypass. MMCTS. Doi: 10.1510/mmcts.2005.001610

  20. Jegger D, Chassot PG, Bernath MA, Horisberger J, Gersbach P, Tozzi P, Delay D, von Segesser LK (2006) A novel technique using echocardiography to evaluate venous cannula performance perioperatively in CPB cardiac surgery. Eur J Cardio-thorac Surg 29:525–529

    Article  Google Scholar 

  21. Corno AF, Horisberger J, Jegger D, von Segesser LK (2004) Right atrial surgery with un-snared inferior vena cava. European Journal for Cardiothoracic Surgery 26:219–220

    Article  Google Scholar 

  22. Delay D, Lardi C, Jaussi A, von Segesser LK (2005) Hepato-atrial anastomosis, the “other Senning operation” for treatment of Budd-Chiari syndrome. Swiss Medical Weekly 135:235–237

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardio-Vascular Surgery, CHUV, CCV, BH 10-275, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    L. K. von Segesser, E. Ferrari, D. Delay, J. Horisberger & P. Tozzi

Authors
  1. L. K. von Segesser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Delay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Horisberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Tozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. K. von Segesser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Segesser, L.K., Ferrari, E., Delay, D. et al. Herzentlastung mittels EKZ vor der Resternotomie. Z Herz- Thorax- Gefäßchir 21, 206–212 (2007). https://doi.org/10.1007/s00398-007-0591-3

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-007-0591-3

Schlüsselwörter

Key words

Search

Navigation