Improved Cardiac Relief by Additional Venous Cannula during Minimally Invasive Mitral Valve Repair

Objectives: Today the minimally invasive mitral valve repair (MKR) is a standardized and approved procedure. In the last few years, half of all single MKR in Germany were performed on a minimally invasive basis. However, there are still limitations. Many surgeons report problems with the venous line of the extracorporeal circulation. It is difficult to optimize the venous drainage. For this purpose, some cardiotechnicians use vacuum assistance. Other surgeons used an additional venous cannula into the jugular vein, depending on body size and weight. For this reason we were looking for a simple solution to this problem.

Methods: The minimally invasive MKR in our department are performed though right mini-thoracotomy with a 5 cm incision. The cannulation for the extracorporeal circulation is performed via the femoral artery (Medtronic Bio-Medicus NextGen Femoral Arterial Cannulae 17 or 19F) and the femoral vein (Medtronic Bio-Medicus NextGen Femoral Venous Cannulae 19 to 23F). After opening the pericardium, a second venous cannula (Medtronic DLP Malleable Single Stage Venous Cannulae 24F) is placed over the superior caval vein with the tip into the right atrium. The MKR is then performed. 7 patients with different body size and weight have been underwent this procedure in our department with this additional cannula.

Results: In all 7 patients, the additional venous cannula was able to achieve a better view of the situs. The movement of the surgeon was not affected by the additional application of the venous cannula though the mini-thoracotomy. All 7 patients showed a uneventful hospital stay, could be extubated on the same day and to be moved to the normal ward the following day.

Conclusion: The additional cannulation of the superior caval vein under sight is a simple and safe method. The puncture and thus the risk of injury to the jugular vein and the lung is avoided. In addition, use of vacuum at the extracorporeal circulation and the associated additional damage to the corpuscular blood components are not necessary. Since the cannulation of the superior caval vein is a standard procedure in cardiac surgery, we consider the method as a good alternative to the cannulation of the jugular vein or the application of vacuum in minimally invasive mitral valve repair. Of course, further patients will be necessary.