Hemolysis at Different Vacuum Levels during Vacuum-Assisted Venous Drainage: A Prospective Randomized Clinical Trial

Abstract

Background There are several reports on the application of variable degrees of vacuum pressure to hardshell venous reservoirs. The aim of the current study was to compare the hemolytic effects of vacuum-assisted venous drainage (VAVD) at two different vacuum levels with the classical gravity siphon method.

Methods A prospective, equally randomized (1: 1: 1), parallel group study was performed in elective coronary artery bypass grafting (CABG) operations. Patients (n = 162) were divided into three groups: gravity siphon (group 1, n = 55), VAVD at -40 mmHg (group 2, n = 55) and VAVD at -80 mmHg (group 3, n = 52). Hemolysis tests were performed at 2, 24 and 48 h following the operations.

Results There were no deaths in this study. Plasma-free hemoglobin (PfHb) levels showed a difference at 2 h (p < 0.001) compared to 24 h (p = 0.02) between the groups. Haptoglobin (Hp) levels also revealed hemolysis in groups 2 and 3 at all sampling times.

Conclusions Constant negative suction at -80 mmHg during elective coronary bypass operations caused more hemolysis. We do not recommend a constant suction of -80 mmHg for VAVD.

Keywords

cardiopulmonary bypass CPB - coronary artery bypass grafts surgery CABG - hematology - hemolysis - VAVD - coronary bypass - vacuum pressure

• References

• 1 Münster K, Andersen U, Mikkelsen J, Pettersson G. Vacuum assisted venous drainage (VAVD). Perfusion 1999; 14: 419-423
• 2 Borrelli U, Al-Attar N, Detroux M , et al. Compact extracorporeal circulation: reducing the surface of cardiopulmonary bypass to improve outcomes. Surg Technol Int 2007; 16: 159-166
• 3 Pappalardo F, Corno C, Franco A , et al. Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial. Perfusion 2007; 22: 317-322
• 4 Ojito JW, Hannan RL, Miyaji K , et al. Assisted venous drainage cardiopulmonary bypass in congenital heart surgery. Ann Thorac Surg 2001; 71: 1267-1271
• 5 Willcox TW, Mitchell SJ, Gorman DF. Venous air in the bypass circuit: a source of arterial line emboli exacerbated by vacuum-assisted drainage. Ann Thorac Surg 1999; 68: 1285-1289
• 6 Lapietra A, Grossi EA, Pua BB , et al. Assisted venous drainage presents the risk of undetected air microembolism. J Thorac Cardiovasc Surg 2000; 120: 856-862
• 7 Bevilacqua S, Matteucci S, Ferrarini M , et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion 2002; 17: 57-61
• 8 Shin H, Yozu R, Maehara T , et al. Vacuum-assisted cardiopulmonary bypass in minimally invasive cardiac surgery: its feasibility and effects on hemolysis. Artif Organs 2000; 24: 450-453
• 9 Mueller XM, Tevaearai HT, Horisberger J, Augstburger M, Burki M, von Segesser LK. Vacuum-assisted venous drainage does not increase trauma to blood cells. ASAIO 2001; 47: 651-654
• 10 Fiorucci A, Gerometta PS, DeVecchi M, Guzman C, Costantino ML, Arena V. In vitro assessment of the vacuum-assisted venous drainage (VAVD) system: risks and benefits. Perfusion 2004; 19: 113-117
• 11 Hayashi Y, Kagisaki K, Yamaguchi T , et al. Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. Eur J Cardiothorac Surg 2001; 20: 621-626
• 12 Colangelo N, Torracca L, Lapenna E, Moriggia S, Crescenzi G, Alfieri O. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion 2006; 21: 361-365
• 13 Murai N, Cho M, Okada S , et al. Venous drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage. J Artif Organs 2005; 8: 91-94
• 14 Schulz KF, Altman DG, Moher D. CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-732
• 15 Society of Thoracic Surgeons Blood Conservation Guideline Task Force. Ferraris VA, Ferraris SP, Saha SP , et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007; 83 (5 Suppl.) S27-S86
• 16 National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1-S266
• 17 Vercaemst L. Hemolysis in cardiac surgery patients undergoing cardiopulmonary bypass: a review in search of a treatment algorithm. J Extra Corpor Technol 2008; 40: 257-267
• 18 Gregoretti S. Suction-induced hemolysis at various vacuum pressures: implications for intraoperative blood salvage. Transfusion 1996; 36: 57-60
• 19 Lau CL, Posther KE, Stephenson GR , et al. Mini-circuit cardiopulmonary bypass with vacuum-assisted venous drainage: feasibility of an asanguineous prime in the neonate. Perfusion 1999; 14: 389-396
• 20 Kiyama H, Imazeki T, Katayama Y, Murai N, Mukouyama M, Yamauti N. Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery. J Artif Organs 2003; 6: 20-24
• 21 Cirri S, Negri L, Babbini M , et al. Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques. Perfusion 2001; 16: 313-318
• 22 Baskett RJ, Ghali WA, Maitland A, Hirsch GM. The intraaortic balloon pump in cardiac surgery. Ann Thorac Surg 2002; 74: 1276-1287