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Small access (30F) clinical central venous smart cannulation: is it adequate?

Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, CHUV, CCV, BH 10-275, CH-1011, Lausanne, Switzerland

*Corresponding author. Tel.: +41 21 314 22 79; fax: +41 21 314 29 78.

E-mail address: ludwig.von-segesser{at}chuv.ch (L.K. von Segessar).

Objectives: To assess the performance of 45F vs. 36F smartcanula^® in CPB with gravity drainage alone. Methods: Twenty patients were randomly assigned to two groups receiving for venous drainage a smartcanula^® which is collapsed over a mandrel for trans-atrial insertion into the inferior vena cava and expanded in situ to either 45F or 36F. Results: Valve replacement/repair was realized in 7/10 and/or CABG in 6/10 for 36F (69±13 years) vs. 5/10 and 5/10, respectively, for 45F (63±11 years: NS). Body weight and surface area (BSA) were 83±9 kg (1.9±0.2 m², max 2.2 m²) for 36F vs. 79±6 kg: NS (1.9±0.1 m² (NS), max 2.1 m²) for 45F. Insertion and access orifice diameter (area) was 6 mm and 10 mm (78.5 mm²) for the 36F vs. 6 mm and 13 mm (132 mm²) for the 45F (+69%). Calculated target pump flow (2.4 l/min/m²) was 4.7±0.4 l/min for 36F vs. 4.5±0.3 l/min for 45F. Achieved pump flow accounted for 5.0±0.3 l/min for 36F (8% above target) vs. 4.8±0.3 l/min for 45F (8% above target): NS. The water balance during the pump run (clear volume added minus hemofilter and urine output) was 2.2±0.3 l for 36F vs. 2.0 l for 45F: NS. Conclusion: Due to its ‘open’ wall (the vena cava provides the seal), its reduced wall thickness (range: 0.0–0.4 mm), and its self-expanding design, the 36F smartcanula^® requiring a 30F access orifice has sufficient drainage capacity by gravity alone for full CPB in adults with a BSA up to 2.2 mm².

Key Words: Cannula; Venous drainage; Gravity drainage; Cardiopulmonary bypass; Augmentation; Perfusion; Small access; Minimal invasive

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