Vacuum-assisted venous drainage in adult open-heart surgery: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Gang ¹ , GAO Sizhe ¹ , WANG Jian ¹ , ZHOU Chun ¹ , YAN Shujie ¹ , WANG Qian ¹ , TENG Yuan ¹ , LIU Yan ² , CHEN Yu ³ ,  JI Bingyang ¹

1. Department of Cardiopulmonary Bypass, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Cardiopulmonary Bypass, Wuhan Asia Heart Hospital, Wuhan, 430022, P. R. China;
3. Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, 100044, P. R. China;

Corresponding author：

JI Bingyang, Email: jibingyang@fuwai.com

Keywords：

Cardiopulmonary bypass; vacuum-assisted venous drainage; cardiac surgery; randomized controlled trial

DOI：

10.7507/1007-4848.202101057

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Objective To analyze the safety and efficacy of vacuum-assisted venous drainage (VAVD) in cardiac surgery under cardiopulmonary bypass (CPB).Methods A total of 180 patients from 3 centers between November 17, 2017 and October 1, 2018 were enrolled and randomly assigned to a VAVD group and a gravity drainage (GD) group by 1∶1 ratio. During the open-heart surgery under CPB, the VAVD group completely relied on VAVD, and the GD group used conventional GD. The primary endpoint was arterial flow before CPB, 15 min after aortic cross-clamping and rewarming to 36 °C of nasopharyngeal temperature. The secondary endpoints included hematocrit, hemoglobin concentration, blood product transfusion, etc. The safety endpoint was free hemoglobin concentration, etc.Results The full analysis set contained 175 patients, 87 in the VAVD group and 88 in the GD group. Patients in the VAVD group were aged 52.8±12.0 years, and males accounted for 55.2%; patients in the GD group were aged 51.4±12.1 years, and males accounted for 59.1%. The demographic characteristics between the two groups were not statistically different. Compared to the GD group, the VAVD group could provide comparable arterial flow in CPB [average of 3 time points, 2.37±0.22 L/(min·m²) vs. 2.41±0.25 L/(min·m²), P=0.271], while not elevating free hemoglobin concentration.Conclusion VAVD can provide enough venous drainage, while not elevating free hemoglobin concentration or damaging blood.

Citation： LIU Gang, GAO Sizhe, WANG Jian, ZHOU Chun, YAN Shujie, WANG Qian, TENG Yuan, LIU Yan, CHEN Yu, JI Bingyang. Vacuum-assisted venous drainage in adult open-heart surgery: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1460-1465. doi: 10.7507/1007-4848.202101057 Copy

1.	Stoney WS. Evolution of cardiopulmonary bypass. Circulation, 2009, 119(21): 2844-2853.
2.	吉冰洋, 闫姝洁, 章晓华, 等. 从经验到循证: 《2019 欧洲成人心脏手术心肺转流指南》解读. 中国体外循环杂志, 2020, 18(1): 3-7.
3.	Guimarães DP, Caneo LF, Matte G, et al. Impact of vacuum-assisted venous drainage on forward flow in simulated pediatric cardiopulmonary bypass circuits utilizing a centrifugal arterial pump head. Braz J Cardiovasc Surg, 2020, 35(2): 134-140.
4.	Sathianathan S, Nasir R, Wang S, et al. In vitro evaluation of Capiox FX05 and RX05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum-assisted venous drainage levels. Artif Organs, 2020, 44(1): 28-39.
5.	Peng R, Ba J, Wang C, et al. A new venous drainage technique in minimally invasive redo tricuspid surgery: Vacuum-assist venous drainage via a single femoral venous cannula. Heart Lung Circ, 2017, 26(2): 201-204.
6.	刘刚, 李勇男, 刁晓林, 等. 新型改良低预充体外循环系统的临床应用. 中国体外循环杂志, 2020, 18(5): 295-300.
7.	Wahba A, Milojevic M, Boer C, et al. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg, 2020, 57(2): 210-251.
8.	Banbury MK, White JA, Blackstone EH, et al. Vacuum-assisted venous return reduces blood usage. J Thorac Cardiovasc Surg, 2003, 126(3): 680-687.
9.	胡盛寿, 纪宏文, 孙寒松, 等. 心血管手术患者血液管理专家共识. 中国输血杂志, 2018, 31(4): 321-325.
10.	Gao S, Li Y, Diao X, et al. Vacuum-assisted venous drainage in adult cardiac surgery: A propensity-matched study. Interact Cardiovasc Thorac Surg, 2020, 30(2): 236-242.
11.	Kwak JG, Lee J, Park M, et al. Hemolysis during open-heart surgery with vacuum-assisted venous drainage at different negative pressures in pediatric patients weighing less than 10 kilograms. World J Pediatr Congenit Heart Surg, 2017, 8(2): 161-165.
12.	Pagano D, Milojevic M, Meesters MI, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg, 2018, 53(1): 79-111.
13.	Ferraris VA, Brown JR, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 2011, 91(3): 944-982.
14.	Aydin S, Cekmecelioglu D, Celik S, et al. The effect of vacuum-assisted venous drainage on hemolysis during cardiopulmonary bypass. Am J Cardiovasc Dis, 2020, 10(4): 473-478.

1. Stoney WS. Evolution of cardiopulmonary bypass. Circulation, 2009, 119(21): 2844-2853.
2. 吉冰洋, 闫姝洁, 章晓华, 等. 从经验到循证: 《2019 欧洲成人心脏手术心肺转流指南》解读. 中国体外循环杂志, 2020, 18(1): 3-7.
3. Guimarães DP, Caneo LF, Matte G, et al. Impact of vacuum-assisted venous drainage on forward flow in simulated pediatric cardiopulmonary bypass circuits utilizing a centrifugal arterial pump head. Braz J Cardiovasc Surg, 2020, 35(2): 134-140.
4. Sathianathan S, Nasir R, Wang S, et al. In vitro evaluation of Capiox FX05 and RX05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum-assisted venous drainage levels. Artif Organs, 2020, 44(1): 28-39.
5. Peng R, Ba J, Wang C, et al. A new venous drainage technique in minimally invasive redo tricuspid surgery: Vacuum-assist venous drainage via a single femoral venous cannula. Heart Lung Circ, 2017, 26(2): 201-204.
6. 刘刚, 李勇男, 刁晓林, 等. 新型改良低预充体外循环系统的临床应用. 中国体外循环杂志, 2020, 18(5): 295-300.
7. Wahba A, Milojevic M, Boer C, et al. 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg, 2020, 57(2): 210-251.
8. Banbury MK, White JA, Blackstone EH, et al. Vacuum-assisted venous return reduces blood usage. J Thorac Cardiovasc Surg, 2003, 126(3): 680-687.
9. 胡盛寿, 纪宏文, 孙寒松, 等. 心血管手术患者血液管理专家共识. 中国输血杂志, 2018, 31(4): 321-325.
10. Gao S, Li Y, Diao X, et al. Vacuum-assisted venous drainage in adult cardiac surgery: A propensity-matched study. Interact Cardiovasc Thorac Surg, 2020, 30(2): 236-242.
11. Kwak JG, Lee J, Park M, et al. Hemolysis during open-heart surgery with vacuum-assisted venous drainage at different negative pressures in pediatric patients weighing less than 10 kilograms. World J Pediatr Congenit Heart Surg, 2017, 8(2): 161-165.
12. Pagano D, Milojevic M, Meesters MI, et al. 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg, 2018, 53(1): 79-111.
13. Ferraris VA, Brown JR, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 2011, 91(3): 944-982.
14. Aydin S, Cekmecelioglu D, Celik S, et al. The effect of vacuum-assisted venous drainage on hemolysis during cardiopulmonary bypass. Am J Cardiovasc Dis, 2020, 10(4): 473-478.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Vacuum-assisted venous drainage in adult open-heart surgery: A randomized controlled trial

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