Comparison of venous cannulation strategies in minimally invasive direct coronary artery bypass surgery

Year 2025, Volume: 50 Issue: 4, 1053 - 1061, 22.12.2025

Tolga Onur Badak , Ferid Cereb

https://doi.org/10.17826/cumj.1721130

Abstract

Purpose: This study aimed to quantitatively compare the efficacy of venous drainage and the requirements for vacuum-assisted venous drainage (VAVD) between bicaval and multistage femoral venous cannulation strategies in minimally invasive direct coronary artery bypass (MIDCAB).
Materials and Methods: In this retrospective, single-center study, 60 patients who underwent MIDCAB between 2018 and 2024 were analyzed. Thirty patients received bicaval cannulation via the right internal jugular and femoral veins (Group 1), while 30 patients underwent single cannulation using a multistage femoral venous cannula (Group 2). Primary outcomes included venous reservoir volume at the initiation of cardiopulmonary bypass (CPB) and the need for VAVD. Secondary outcomes comprised CPB duration and major postoperative complications.
Results: Mean pump flow rate was comparable between groups (Group 1: 4.5 ± 0.4 L/min vs. Group 2: 4.3 ± 0.5 L/min). However, mean initial venous reservoir volume was greater in Group 1 (824 ± 124 mL vs. 641 ± 95 mL). The requirement for VAVD was more frequent in Group 2 (82.7% vs. 24.1%). Additionally, CPB duration was longer in Group 2 (191.9 ± 24.4 min vs. 149.6 ± 39.6 min). No major postoperative complications were observed in either group.
Conclusion: Multistage femoral venous cannulation was associated with inferior venous drainage, necessitating more frequent vacuum support and resulting in prolonged CPB times. Bicaval cannulation may therefore provide a more reliable approach to achieving optimal surgical conditions in MIDCAB.

Keywords

Bicaval venous cannulation , multistage single venous cannulation , vacuum , minimally invasive direct coronary artery bypass

Minimal invaziv direkt koroner arter baypas cerrahisinde venöz kanülasyon stratejilerinin karşılaştırılması

Abstract

Amaç: Bu çalışma, Minimal invaziv direkt koroner arter baypas (MIDCAB) bikaval ve multistage femoral venöz kanülasyon stratejileri arasında venöz drenaj etkinliği ile vakum destekli venöz drenaj (VAVD) gereksinimlerini nicel olarak karşılaştırmayı amaçlamıştır.
Gereç ve Yöntem: Bu retrospektif, tek merkezli çalışmada, 2018-2024 yılları arasında MIDCAB uygulanan 60 hasta incelendi. Otuz hastaya sağ internal juguler ve femoral venler yoluyla bikaval kanülasyon (Grup 1), 30 hastaya ise tekli multistage femoral venöz kanül ile kanülasyon uygulandı (Grup 2). Birincil sonuçlar, kardiyopulmoner bypass (KPB) başlangıcındaki venöz rezervuar hacmi ve VAVD ihtiyacıydı. İkincil sonuçlar arasında KPB süresi ve majör postoperatif komplikasyonlar yer aldı.
Bulgular: Ortalama pompa akım hızı gruplar arasında benzerdi (Grup 1: 4,5 ± 0,4 L/dakika ve Grup 2: 4,3 ± 0,5 L/dakika). Bununla birlikte, ortalama başlangıç venöz rezervuar hacmi Grup 1'de daha yüksekti (824 ± 124 mL ve 641 ± 95 mL). VAVD gereksinimi Grup 2'de daha sıktı (%82,7 ve %24,1). Ek olarak, KPB süresi Grup 2'de daha uzundu (191,9 ± 24,4 dakika ve 149,6 ± 39,6 dakika). Her iki grupta da majör postoperatif komplikasyon gözlenmedi.
Sonuç: Tek kanülasyon bölgesinin potansiyel avantajlarına rağmen, multistage femoral venöz kanülasyon, bikaval kanülasyona kıyasla daha düşük venöz drenaj, daha sık vakum desteği ihtiyacı ve daha uzun KPB süreleri ile ilişkili bulundu. Bu nedenle, bikaval kanülasyon, MIDCAB'ta optimal cerrahi koşulların sağlanması için daha güvenilir bir strateji sunabilir.

Keywords

Bikaval venöz kanülasyon , multistage single venöz kanülasyon , vakum , minimal invaziv direkt koroner arter bypass

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