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

Yıl 2025, Cilt: 50 Sayı: 4, 1053 - 1061, 22.12.2025

Tolga Onur Badak , Ferid Cereb

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

https://izlik.org/JA76RD44ZX

Öz

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.

Anahtar Kelimeler

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

https://izlik.org/JA76RD44ZX

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Lamelas J, Aberle C, Macias AE, Alnajar A. Cannulation strategies for minimally invasive cardiac surgery. Innovations (Phila). 2020;15:261-9.
• Chan EY, Lumbao DM, Iribarne A, Easterwood R, Yang JY, Cheema FH et al. Evolution of cannulation techniques for minimally invasive cardiac surgery: a 10-year journey. Innovations (Phila). 2012;7:9-14.
• Woo YJ, Nacke EA. Minimally invasive robotic mitral valve surgery. Expert Rev Med Devices. 2023;20:367-74.
• Dieberg G, Smart NA, King N. Minimally invasive cardiac surgery: a systematic review and meta-analysis. Int J Cardiol. 2016;223:554-60.
• Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting—a 25-year review. J Thorac Dis. 2021;13:1922-44.
• Ramchandani M, Al Jabbari O, Abu Saleh WK, Ramlawi B. Cannulation strategies and pitfalls in minimally invasive cardiac surgery. Methodist Debakey Cardiovasc J. 2016;12:10-3.
• Matsuo K, Fujita A, Kohta M, Yamanaka K, Inoue T, Okada K et al. Successful double-catcher coil embolization of an iatrogenic subclavian artery to internal jugular vein fistula after minimally invasive cardiac surgery. Ann Vasc Surg. 2020;68:571.e15-571.e20.
• Falay D, Schindler E, Mikus M, Boulos A, Sylvia S, Alina S et al. Ultrasound-guided supraclavicular cannulation of the left brachiocephalic versus right internal jugular vein: comparative analysis of central venous catheter-associated complications. Paediatr Anaesth. 2023;33:219-28.
• Hessel EA 2nd. A brief history of cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth. 2014;18:87-100.
• Kirov H, Caldonazo T, Runkel A, Fischer J, Tasoudis P, Mukharyamov M et al. Percutaneous versus surgical femoral cannulation in minimally invasive cardiac surgery: a systematic review and meta-analysis. Innovations (Phila). 2024;19:247-53.
• Pausch J, Weimann J, Silaschi M, Alaj E, Seidiramool V, Kofler M et al. Percutaneous cannulation for minimally invasive heart valve surgery: results from a multicenter registry. Eur J Cardiothorac Surg. 2025;67:ezaf219.
• Cheng S, Gu T, Xiu Z, Wu L, Gao R, Gao Y. Application of vacuum-assisted venous drainage technology in minimally invasive cardiac surgery. Zhongguo Yi Liao Qi Xie Za Zhi. 2011;35:428-30.
• Gao S, Li Y, Diao X, Yan S, Liu G, Liu M et al. Vacuum-assisted venous drainage in adult cardiac surgery: a propensity-matched study. Interact Cardiovasc Thorac Surg. 2020;30:236-42.
• Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17:57-61.
• Durandy Y. Vacuum-assisted venous drainage, angel or demon: PRO? J Extra Corpor Technol 2013;45:122-7.
• Köse AZ. Effect of vacuum assisted venous drainage (VAVD) technology on liver functions in coronary artery bypass graft (CABG) surgery. Turk J Clin Cardiov Perfusion. 2025;2:92-7.
• Liu Z, Maimaitiaili A, Ma X, Dong S, Wei W, Wang Q et al. Initial experience and favorable outcomes on cannulation strategies and surgical platform construction in fully video-assisted thoracoscopic cardiac surgery. Front Cardiovasc Med. 2024;11:1414333.
• Alaj E, Seidiramool V, Ciobanu V, Bakhtiary F, Monsefi N. Short-term clinical results of minimally invasive direct coronary artery bypass. J Clin Med. 2024;13:3124.
• Piekarski F, Rohner M, Monsefi N, Bakhtiary F, Velten M. Anesthesia for minimally invasive cardiac surgery: the bonn heart center protocol. J Clin Med. 2024;13:3939.
• Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D et al. Contemporary minimally invasive cardiac surgery. AST CE Online. 2023;483:65-81.