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Literature about the smart canula ® |
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N °57 Perfusion 2018, Vol. 33(1S) 18–23
New, optimized, dual-lumen cannula for veno-venous ECMO
LK von Segesser, D Berdajs, S Abdel-Sayed, E Ferrari, M Halbe, M Wilhelm and F Maisano
Objective: The present study was designed to assess in vivo a new, optimized,
virtually wall-less, dual-lumen, bi-caval cannula for veno-venous ECMO in comparison to a commercially available cannula.
Methods: Veno-venous extracorporeal membrane oxygenation (ECMO) was carried out in a bovine study (n=5,bodyweight 75±5kg).
Following systemic heparinization, ECMO was established in a trans-jugular fashion through a calibrated 23F orifice,
using a new, optimized, virtually wall-less, dual-lumen, bi-caval 24F cannula (Smartcanula LLC, Lausanne, Switzerland)
versus a commercially available 23F bi-caval, dual-lumen control cannula (Avalon Elite®, Maquet, Rastatt, Germany)
in a veno-venous ECMO setup. Veno-venous ECMO was initiated at 500 revolutions per minute (RPM) and increased by
incremental steps of 500 RPM up to 2500 RPM. Catheter outlet pressure, catheter inlet pressure, oxygen saturation
and pump flow were recorded at each stage.
Results: Mean flow accounted for 0.37±0.04 L/min for wall-less versus 0.29± 0.07 L/min for control at 500 RPM,
0.97±0.12 versus 0.67±0.06 at 1000 RPM, 1.60±0.14 versus 1.16±0.08 at 1500 RPM, 2.31±0.13 versus 1.52±0.13 for
2000 RPM and 3.02±0.5 versus 2.11±0.18 (p<0.004). The mean venous suction required was 19±8 mmHg for wall-less
versus 20±3 mmHg for control at 500 RPM, 7±3 versus 9±4 for 1000 RPM, -11±10 versus -12±8 at 1500 RPM, -39±15
versus -49±10 for 2000 RPM and -60±28 versus -94±7 for 2500 RPM. The mean venous injection pressure accounted
for 29±7 mmHg for wall-less versus 27±5 mmHg for control at 500 RPM, 50±6 versus 61±7 at 1000 RPM, 89±10 versus
99±17 for 1500 RPM, 142±14 versus 161±9 at 2000 RPM and 211±41 versus 252 ±3 for 2500 RPM.
Conclusion: Compared to the commercially available control cannula, the new, optimized, virtually wall-less,
dual-lumen, bi-caval 24F cannula allows for significantly higher blood flows, requires less suction and results in lower injection pressures in vivo.
N °56 Innovations (Phila). 2018 Mar/Apr;13(2):104-107. doi: 10.1097/IMI.0000000000000478
Clinical Experience in Minimally Invasive Cardiac Surgery With Virtually Wall-Less Venous Cannulas
E Ferrari E, LK von Segesser, D Berdajs, L Müller, M Halbe, F Maisano
OBJECTIVE: Inadequate peripheral venous drainage during minimally invasive cardiac surgery (MICS)
is a challenge and cannot always be solved with increased vacuum or increased centrifugal pump speed.
The present study was designed to assess the benefit of virtually wall-less transfemoral venous cannulas during MICS.
METHODS: Transfemoral venous cannulation with virtually wall-less cannulas (3/8″ 24F 530-630-mm ST) was
performed in 10 consecutive patients (59 ± 10 years, 8 males, 2 females) undergoing MICS for mitral (6),
aortic (3), and other (4) procedures (combinations possible). Before transfemoral insertion of wall-less cannulas,
a guidewire was positioned in the superior vena cava under echocardiographic control. The wall-less cannula was then
fed over the wire and connected to a minimal extracorporeal system. Vacuum assist was used to reach a target flow
of 2.4 l/min per m with augmented venous drainage at less than -80 mm Hg.
RESULTS: Wall-less venous cannulas measuring either 630 mm (n = 8) in length or 530 mm (n = 2) were
successfully implanted in all patients. For a body size of 173 ± 11 cm and a body weight of 78 ± 26 kg,
the calculated body surface area was 1.94 ± 0.32 m. As a result, the estimated target flow was 4.66 ± 0.78 l/min,
whereas the achieved flow accounted for 4.98 ± 0.69 l/min (107% of target) at a vacuum level of 21.3 ± 16.4 mm Hg.
Excellent exposure and "dry" intracardiac surgical field resulted.
CONCLUSIONS: The performance of virtually wall-less venous cannulas designed for augmented peripheral
venous drainage was tested in MICS and provided excellent flows at minimal vacuum levels, confirming
an increased performance over traditional thin wall cannulas. Superior results can be expected for routine use.
N °55 ASAIO J. 2016 Jul-Aug;62(4):427-31. doi: 10.1097/MAT.0000000000000377
New Dual Lumen Self-Expanding Catheter Design Requiring Less Suction.
S Abdel-Sayed , LK von Segesser
Contribution of venovenous extracorporeal membrane oxygenation (v-v ECMO) to gas transfer is flow dependent.
Catheter design is a key factor for optimal pressure/flow rate relationship. This study was designed for the
assessment of a new self-expanding dual lumen catheter design versus the current standard. Outlet pressure/flow
rate and inlet pressure/flow rate for a new Smart catheter with self-expanding dual lumen design constricted
to 27 F with 5 mm long constrictor corresponding to the percutaneous path versus Avalon 27 F catheter (control)
were compared on a flow bench with a Biomedicus centrifugal pump. Flow, pump inlet pressure and outlet
pressure were determined at 500, 1,000, 1,500, 2,000, and 2,500 revolutions per minute (RPM).
At 500 RPM and with a 5 mm long constrictor (1,000; 1,500; 2,000; and 2,500 RPM), catheter outlet pressure
values were -0.13 ± 0.07 mm Hg (-2.55 ± 0.06; -7.38 ± 0.14; -15.03 ± 0.44; -26.46 ± 0.39) for self-expanding
versus -2.93 ± 0.23* (-10.60 ± 0.14; -22.74 ± 0.34; -38.43 ± 0.41; -58.25 ± 0.40)*: p < 0.0001* for control.
The flow values were 0.61 ± 0.01 L/min (1.64 ± 0.03, 2.78 ± 0.02; 4.07 ± 0.04; 5.37 ± 0.02) for self-expanding
versus 1.13 ± 0.06*; (2.19 ± 0.04; 3.30 ± 0.03; 4.30 ± 0.03; 5.30 ± 0.03)*: p < 0.0001* for control.
The corresponding catheter inlet flow rates of the self-expanding catheter were slightly more than
that of the control. For the given setup, our evaluation demonstrated that the new dual lumen
self-expanding catheter requires lower catheter outlet pressures for higher flows as compared to the current standard.
N °54 Innovations (Phila) 2016; 11: 278-81
New, virtually wall-less cannulas for augmented venous drainage in minimally invasive cardiac surgery
LK von Segesser, D Berdajs, S Abdel-Sayed, P Tozzi, E Ferrari, F Maisano
Inadequate venous drainage during minimally invasive cardiac surgery becomes
most evident when the blood trapped in the pulmonary circulation floods the
surgical field. The present study was designed to assess the in vivo performance
of new, thinner, virtually wall-less, venous cannulas designed for augmented
venous drainage in comparison to traditional thin-wall cannulas.
Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with
percutaneous venous access over the wire, serial dilation up to 18 F and
insertion of either traditional 19 F thin wall, wire-wound cannulas, or
through the same access channel, new, thinner, virtually wall-less, braided
cannulas designed for augmented venous drainage. A standard minimal extracorporeal
circuit set with a centrifugal pump and a hollow fiber membrane oxygenator,
but no in-line reservoir was used. One hundred fifty pairs of pump-flow and
required pump inlet pressure values were recorded with calibrated pressure
transducers and a flowmeter calibrated by a volumetric tank and timer at
increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments).
Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45
l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM,
5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for
9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, -42.4 ± 26.7 versus
-123 ± 51.1 at 2500 RPM, and -126.7 ± 55.3 versus -313 ± 116.7 for 3500 RPM.
At the well-accepted pump inlet pressure of -80 mm Hg, the new, thinner, virtually
wall-less, braided cannulas provide unmatched venous drainage in vivo.
Early clinical analyses have confirmed these findings.
N °53
Swiss Medical Weekly 2016; 146: w 14304
Prevention and therapy of leg ischemia in extracorporeal life support and extracorporeal membrane oxygenation with peripheral cannulation
LK von Segesser, S Marinakis, D Berdajs, E Ferrari, M Wilhelm, F Maisano
Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal Life Support
(ECLS) have been around for a long time, but it is only in recent years with
the advent of acute respiratory distress syndrome consecutively to influence A
(H1N1) infection that these life saving technologies have seen a broader application.
Although the results of ECLS and ECMO are perceived as encouraging in general,
there are still disturbing complications related to peripheral cannulation in
general and more specifically to cannulation in the groin. The present review
was designed to assess the magnitude of this latter problem, i.e. leg ischemia
related to ECLS and ECMO in the literature and to identify strategies for
possible therapies and more importantly, prevention.
The search strategy selected identified 7 original articles totalizing 407
patients who underwent veno-arterial ECMO and on large review. For the original
reports, the number of cases with veno-arterial support ranges from 21-143, with,
as far as available, a range of ischemic complications between 11% and 52%, a
reported range of surgical intervention between 9% and 22%, and a leg amputation
rate ranging from 2% to 10%. It appears that the number of reports dealing
with lower extremity ischemia during ECMO increases in parallel with the number
of reports about ECMO. Strategies for early detection of peripheral ischemia,
interventions for efficient reperfusion, and measures for prevention including
new concepts with smaller and eventually bidirectional arterial cannulas are discussed.
N °52 European
Journal of Cardiothoracic Surgery 2015, 10 (Suppl1): A123
How to get a bloodless surgical field in mini-invasive cardiac surgery
LK von Segesser, D Berdajs, S Abdel-Sayed, P Tozzi, E Ferrari
Virtually wall-less cannulas designed for augmented venous drainage allow
for unmatched venous drainage in vivo despite a small 18F access orifice and
relatively low negative pressure.
N °51 European
Journal of Cardio-Thoracic Surgery 2015; 48: 499-501
Use of
self-expanding venous cannula in tricuspid reoperation
Pinon M, Pradas G,
Molina D, Legarra JJ
Tricuspid surgery on cardiopulmonary bypass
with single transfemoral smart cannulation of the right atrium, without
superior and inferior vena caval snaring, is feasible and safe by using a
suitable self-expanding venous cannula. This technique adds to the advantages
of peripheral cannulation by lowering the risk of injuries associated with
reoperation. The limitation of the right atrial surface area that needs to be
exposed reduces the morbidity related to the surgical procedure. Peripheral
cannulation also enhances the surgical field through having no cannula present
in the field. Moreover, excellent venous drainage without augmentation was
achieved here, consistent with previous reports on the use of these cannulae.
Also, complications of vacuum-assisted venous return, such as the collapse of
the caval axis during cardiopulmonary bypass, are avoided, thus providing an
optimal flow and an improved end-organ perfusion.
N
°50 Swiss Medical Weekly 2014 DOI: 10.4414/smw.2014.14022
Late
removal of retrievable caval filters
von Segesser L, Ferrari E, Tozzi P,
Abdel-Sayed S, Berdajs D
Retrievable caval filters inserted for
thrombo-embolic prophylaxis in the acute setting often become permanent despite
the initial decision of temporary use (designed implant duration < 30 days).
However, such “forgotten“ retrievable devices can still be removed with a great
chance of success up to three months after implantation. Conventional
percutaneous removal techniques (catheters, hooks, lassos, etc.) may be
sufficient up to sixteen months after implantation whereas more sophisticated
catheter techniques have been shown to be successful up to 83 months or more
than seven years of implant duration. Tilting, migrating, or misplaced devices
should be removed early on, and replaced if indicated with a device which is
both, efficient and retrievable.
N °49 Interactive
CardioVascular and Thoracic Surgery 2014 DOI: 10.1093/iscvts/ivu
318
Venous cannula performance assessment in a realistic caval tree
model
Li L. Abdel-Sayed S, Berdajs D, Ferrari E, von Segesser
L
The objective of this study was to assess cannula performance for
virtually wall-less cannulas designed for augmented venous drainage versus
standard percutaneous thin-walled venous cannulas in a setting of venous
collapse in case of negative pressure. For the thin wall and the wall-less
cannulas, 36 pairs of flow and pressure measurements were realized for three
different centrifugal pump RPM values. The mean Q-values at 1500, 2000 and 2500
RPM were: 3.98 ± 0.01, 6.27 ± 0.02 and 9.81 ± 0.02 l/min for the wall-less
cannula (P <0.0001), versus 2.74 ± 0.02, 3.06 ± 0.05, 6.78 ± 0.02 l/min for
the thin-wall cannula (P <0.0001). The corresponding inlet pressure values
were: −8.88 ± 0.01, −23.69 ± 0.81 and −70.22 ± 0.18 mmHg for the wall-less
cannula (P <0.0001), versus −36.69 ± 1.88, −80.85 ± 1.71 and −101.83 ± 0.45
mmHg for the thin-wall cannula (P <0.0001). The thin-wall cannula showed
mean Q-values 37% less and mean P values 26% more when compared with the
wall-less cannula (P <0.0001).
N °48
Artificial organs 2014 DOI: 10.1111/aor.12369
Effect of inflow
cannula tip design on potential parameters of blood compatibility and
thrombosis
Wong KC, Büsen M, Benzinger C, Gäng R, Bezema M et al.
Cannula tip design strongly affects the function of a cannula and its
potential for blood trauma. Inflow cannulas with conventional tip geometries
(Blunt, blunt with four side holes, beveled with three side ports and cage)
were compared to a custom designed crown tip in vitro using particle flow
velocimetry. Among the five tip geometries, the highest shear volume was
observed for the blunt tip, whereas the crown tip had the lowest recirculation
volume.
N °47 Perfusion 2014 DOI:
10.1177/0267659114560042
How to prevent caval cannula orifice
obstruction during extracorporeal circulation
Abdel-Sayed S, Favre J, von
Segesser LK
Venous cannula orifice obstruction is an underestimated
problem during augmented cardiopulmonary bypass (CPB), which can potentially be
reduced with redesigned, virtually wall-less cannula designs versus traditional
percutaneous control venous cannulas. A bench model, allowing for simulation of
the vena cava with various affluent orifices, venous collapse and a worst case
scenario with regard to cannula position, was developed. Flow (Q) was measured
sequentially for right atrial + hepatic + renal + iliac drainage scenarios,
using a centrifugal pump and an experimental bench set-up (afterload 60 mmHg).
This experimental evaluation demonstrates that the redesigned, virtually
wall-less cannulas, allowing for direct venous drainage at practically all
intra-venous orifices, outperform the commercially available control cannula,
with superior flow at reduced suction levels for all scenarios tested.
N °46 European Journal of Cardio-Thoracic Surgery
2014; 43: 306-312
Caval collapse during cardiopulmonary bypass: a
reproducible bench model
Li L. Abdel-Sayed S, Berdajs D, Tozzi P, von
Segesser L, Ferrari E
Based on data for venous anatomy and
physiology from the literature, a caval tree system is designed (polyethylene,
thickness 0.061 mm), which receives venous inflow from nine afferent veins
representing all major affluent. With water as medium and a preload of 4.4
mmHg, the system has an outflow of 4500 ml/min (Scenario A). After the
insertion of a percutaneous venous cannula (23-Fr), the venous model is
continuously served by the afferent branches in a venous test bench and venous
drainage is augmented with a centrifugal pump (Scenario B).This caval model
provides a realistic picture for the limitations of flow due to spontaneously
reversible atrial chatter versus irreversible venous collapse for a given
negative pressure during CPB. Temporary interruption of negative pressure in
the venous line can allow for recovery of venous drainage. This know-how can be
used not only for testing different cannula designs, but also for further
optimizing perfusion strategies.
N °45 Innovations
2014; 9: 297-301
Performance increase in venous drainage for
mini-invasive heart surgery. Superiority of self-expanding
cannulas
Belkoniene M., Abdel-Sayed S, Favre J., von Segesser
LK
Experimental evaluation of a new 14F self-expanding cannula
designed for use in combination with augmentation by a centrifugal pump (or
vacuum) was to standard 25F percutaneous thin wall cannulas. Superior flow (3.6
l/min to 11.8 l/min) at a fraction of negative pressure (-5.4 to -80.6 mmHg)
was demonstrated for the self-expanding design at all pump speeds of 1500,
2000, 2500, and 300 RPM.
N °44 European Journal
of Cardio-Thoracic Surgery 43 (2013) 665–672
The contraindications
of today are the indications of tomorrow
Ludwig K. von
Segesser
One of the remaining problems during ECMO is the
considerable haemodilution, which can become a major issue. However, stripped
down, integrated pump-oxygenator designs have been developed with minimized
priming volumes below 400 ml for the entire circuit, which allow for stealth
perfusion provided adequate cannulation is realized. Pump flows up to 6 l/min
can be realized without significant modification of the haematocrit. A
different issue is the scavenging of a major part of the circulating blood
volume in the pulmonary circulation in patients with weak or fibrillating
heart, a situation where the aortic valve does not open, and nothing can be
ejected from the left ventricle. Remote pulmonary artery drainage by flexible
wall-less venous cannulas (Smartcanula LLC, Lausanne, Switzerland) introduced
from the groin through the tricuspid and the pulmonary valves is promising for
this scenario.
N ° 43 ASAIO Journal
2013;59:46–51
Prevention of Caval Collapse During Venous Drainage
for CPB
Saad Abdel-Sayed, Julien Favre, Steven Taub,* and Ludwig-Karl von
Segesser
A new plastic self-expanding Smartcanula is designed for
central insertion and prevention of caval collapse. The objective is to assess
the influence of the new design on atrial chatter. Caval collapse over the
entire caval axis, right atrial, hepatic, renal vein, and iliac vein is
realized in drainage tubes with holes at 5 cm distance intervals. Smartcanulas
with various lengths (26 cm [= right atrial], 34 cm [= hepatic], 43 cm [=
renal], and 53 cm [= iliac]) versus two-stage cannulas are compared. The
Smartcanula outperforms significantly the two-stage control cannula. In
addition, direct central smart cannula insertion without guide-wire is
effective.
N ° 42 Anesthesiology. 2013; 119:
365-378
Interactions of Cardiopulmonary Bypass and Erythrocyte
Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine
Patel NN,
Lin H, Jones C, Walkden G, Ray P, Sleeman PA, Angelini GD, Murphy GJ.
Thirty-six pigs were infused with allogeneic 14- or 42-day-old erythrocytes
or they underwent cardiopulmonary bypass after smart cannulation with or
without transfusion of 42-day erythrocyte. Controls received saline. All pigs
were recovered and assessed for pulmonary dysfunction, inflammation, and
endothelial activation at 24 h
N ° 41 Interact
Cardiovasc Thorac Surg. 2012 Oct;15(4):574-7. Epub 2012 Jul 9.
How
to improve flow during cardiopulmonary bypass in an acardia experimental
model.
Marinakis S, Niclauss L, Rolf T, von Segesser LK.
In
extreme scenarios,such as hyperacute rejection of heart transplant, an urgent
heart explantation might be necessary. Veno-arterial cardiopulmonary bypass
after cardiectomy may allow to bridge such a situation. Baseline pump flow was
4.16 ± 0.75 l/min dropping to 2.9 ± 0.63 l/min (p< 0.001) 10 min after
induction of ventricular fibrillation. After cardiectomy with the pulmonary
artery clamped, the pump flow increased non-significantly to 3.20 ± 0.78 l/min.
After declamping, the flow significantly increased to (3.61 ± 0.73 l/min, P(DB
)= 0.009, P(DC )= 0.017), supporting the notion that full cardiopulmonary
bypass in acardia is feasibleprovided adequate drainage of pulmonary
circulation is maintained.
N ° 40 Amsect Abstracts
2012
ECMO Circulatory Support After Cardiectomy; How To Improve
Flow?
Marinakis S, von Segesser L
Purpose: Veno-arterial bypass
is commonly used for cardiorespiratory support in acute cardiac failure. In
extreme scenarios, such as hyperacute rejection of heart transplant, an urgent
heart explantation might be necessary. The aim of this experimental study was
to determine the feasibility and to improve the hemodynamics of a venoarterial
cardiopulmonary bypass after cardiectomy.
Methods: A venoarterial
cardiopulmonary bypass was established in 4 bovine experiments (56 +/- 5 kg) by
the transjugular insertion to the caval axis of a self expanded cannula, with
return through a carotid artery. After baseline measurements (A), ventricular
fibrillation was induced (B), the great arteries were clamped, the heart was
excised and right and left atria remnants, containing the pulmonary veins, were
sutured together leaving an atrial septal defect (ASD) over the cannula in the
caval axis. Measures were taken with the pulmonary artery clamped (C) and
declamped (D).
Results: Initial pump flow (A) was 3.7+/-0.8 L/min dropping
to 2.7+/-0.2 L/min on induction of ventricular fibrillation (B). After
cardiectomy, with the pulmonary artery clamped (C) it continued to decrease to
2.4+/-0.2 L/min, due to pulmonary congestion from the left to right shunt of
bronchial circulation. Finally, after declampation (D), flow significantly
raised, almost to baseline (3.45+/-0.5 L/min), supporting that pulmonary artery
drainage is necessary to maintain cardiac output in acardia.
Conclusions:
Full circulatory support in acardia is feasible, making cardiectomy a
possibility in situations where heart must urgently be explanted. However, in
order to optimise pump flow, pulmonary artery drainage must be assured to avoid
pulmonary congestion and loss of volume.
N ° 39
Int J Artif Organs 2012; 35: 132-138
Characterizing the impact of
minor cannula design modification
Abdel-Sayed S, Favre J, von Segesser
LK
The hydrodynamic behaviour of self-expanding venous cannulas with
either 8 mm versus 9 mm connecting tube measuring 100 mm in length was assessed
on a test bench with a computerized recording system. Flow accounted for
7.22±0.10 l/min for the 8 mm connecting tube versus 7.81±0.04 for the 9 mm
version. A 17% reduced resistance was also observed for the 9 mm connecting
tube. Obviously, even minor cannula design modifications have a significant
impact on drainage.
N ° 38 ACTA-SCTS, Manchester,
April 18-20, 2012: Abstract book 230
A novel and safe approach to
complex aortic surgery
Lu J, Shajar M, Campbell J, Hammond S, Nalk
S
The Smart venous cannula is inserted percutaneously without skin
incision and re-expanded in situ. Superior flow, much smaller access aperture,
and less trauma result. This avoids the need for vacuum assisted drainage and
minimizes trauma to blood components. It particularly improves the venous
drainage of the lower body and hence reduces the ischemic risk to the gut and
the kidneys. Closure of femoral vein in open cannulation can be difficult and
this technique avoids the problem.
N ° 37 Int J
Artif Organs 2012; 35 (2): 132-138
Characterizing the impact of
minor cannula design modification
Saad Abdel-Sayed1, Julien Favre, Ludwig K.
von Segesser
Objective: Bench evaluation of the hydrodynamic behavior
of venous cannulas is a valuable technique for the analysis of their
performance during cardiopulmonary bypass (CPB). The aim of this study was to
investigate the effect of the internal diameter of the extracorporeal
connecting tube of venous cannulas on flow rate (Q), pressure drop (?P), and
cannula resistance (?P/Q2) values, using a computer assisted test
bench.
Methods: An in vitro circuit was set up with silicone tubing between
the test cannula encased in a movable reservoir, and a static reservoir. The
?P, defined as the difference between the drainage pressure and the preload
pressure, was measured using high-fidelity Millar pressure transducers. Q was
measured using an ultrasonic flowmeter. Data display and data recording were
controlled using virtual instruments in a stepwise fashion.
Results: The 27
F Smartcanula® with a 9 mm connecting tube diameter showed 17% less resistance
compared to that with an 8 mm connecting tube diameter. Q values were 7.22±0.1
and 7.81±0.04 L/min for cannulas with 8 mm and 9 mm connecting tube diameters,
respectively. The ?P/Q2 ratio values were 72% lower for the cannula with a 9 mm
connecting tube diameter compared to that with an 8 mm connecting tube
diameter. Q values for the control cannula were 3.94±0.23 and 6.58±0.04 L/min
with 8 mm and 9 mm connecting tube diameters, respectively. The 27 F
Smartcanula ® showed 13% more flow rate compared to the 28 F Medtronic cannula
using the unpaired Student t-test (p<0.0001).
Conclusions: Our results
demonstrated that Q was increased but ?P and ?P/Q2 values were significantly
decreased when the connecting tube diameter was increased for venous cannulas.
The connecting tube diameter significantly affected the resistance to liquid
flow through the cannula. Smartcanulas ® outperform control
cannulas.
N ° 36 Am J Physiol Renal Physiol 301:
F605–F614, 2011
Reversal of anemia with allogenic RBC transfusion
prevents post-cardiopulmonary bypass acute kidney injury in swine
Nishith N.
Patel, Hua Lin, Tibor Toth, Gavin I. Welsh, Ceri Jones, Paramita Ray, Simon C.
Satchell, Philippa Sleeman, Gianni D. Angelini, and Gavin J.
Murphy
Anemia during cardiopulmonary bypass (CPB) is strongly
associated with acute kidney injury in clinical studies; however, reversal of
anemia with red blood cell (RBC) transfusions is associated with further renal
injury. To understand this paradox, we evaluated the effects of reversal of
anemia during CPB with allogenic RBC transfusion in a novel large-animal model
of post-cardiac surgery acute kidney injury with significant homology to that
observed in cardiac surgery patients. Adult pigs undergoing general anesthesia
were allocated to a Sham procedure, CPB alone, Sham_RBC transfusion, or CPB_RBC
transfusion, with recovery and reassessment at 24 h. CPB was associated with
dilutional anemia and caused acute kidney injury in swine characterized by
renal endothelial dysfunction, loss of nitric oxide (NO) bioavailability,
vasoconstriction, medullary hypoxia, cortical ATP depletion, glomerular
sequestration of activated platelets and inflammatory cells, and proximal
tubule epithelial cell stress. RBC transfusion in the absence of CPB also
resulted in renal injury. This was characterized by endothelial injury,
microvascular endothelial dysfunction, platelet activation, and equivalent
cortical tubular epithelial phenotypic changes to those observed in CPB pigs,
but occurred in the absence of severe intrarenal vasoconstriction, ATP
depletion, or reductions in creatinine clearance. In contrast, reversal of
anemia during CPB with RBC transfusion prevented the reductions in creatinine
clearance, loss of NO bioavailability, platelet activation, inflammation, and
epithelial cell injury attributable to CPB although it did not prevent the
development of significant intrarenal vasoconstriction and endothelial
dysfunction. In conclusion, contrary to the findings of observational studies
in cardiac surgery, RBC transfusion during CPB protects pigs against acute
kidney injury. Our study underlines the need for translational research into
indications for transfusion and prevention strategies for acute kidney
injury.
N ° 35 Care Med 2011 Vol. 39, No. 4:
793-802
Prevention of post-cardiopulmonary bypass acute kidney
injury by endothelin A receptor blockade
Nishith N. Patel, MBBS, MRCS; Tibor
Toth, MD, MRCPath; Ceri Jones, BSc; Hua Lin, PhD; Paramita Ray, MB ChB, FRCA;
Sarah J. George, PhD; Gavin Welsh, PhD; Simon C. Satchell, PhD, MRCP; Philippa
Sleeman, BSc; Gianni D. Angelini, MD, FRCS; Gavin J. Murphy, MD,
FRCS
Objective: The aim of this study was to determine whether
administration of a specific endothelin A receptor antagonist, sitaxsentan
sodium, would prevent the development of postcardiopulmonary bypass acute
kidney injury in swine.
Design: Experimental study.
Setting:
Cardiovascular Research Institute.
Interventions: Adult pigs (n _ 8 per
group) were randomized to undergo a sham procedure, cardiopulmonary bypass, or
cardiopulmonary bypass plus administration of endothelin A receptor antagonist
(RA), with recovery and reassessment at 24 hrs.
Measurements and Main
Results: Cardiopulmonary bypass resulted in a significant reduction in
creatinine clearance relative to sham pigs (mean difference for
cardiopulmonary
bypass vs. sham, -50.3 mL/min [95% confidence interval -89.2
to -11.4 mL/min], p= .008). This was reversed by the administration of
endothelin A RA during cardiopulmonary bypass (mean difference for
cardiopulmonary bypass+ endothelin A RA vs. cardiopulmonary bypass, +43.3
mL/min [95% confidence interval +3.3 to +83.4 mL/min], p= .030).
Cardiopulmonary bypass also resulted in a significant rise in the specific
urinary biomarker of acute kidney injury interleukin-18 compared to sham
procedures (mean difference +209 pg/mL [95% confidence interval +119 to +299
pg/mL], p< .001) that was reversed by endothelin A receptor antagonist
administration. Post-cardiopulmonary bypass kidney injury was associated with
vascular endothelial injury and dysfunction,reduced nitric oxide
bioavailability, inflammation, and a significant increase in the expression of
the paracrine vasoconstrictors adenosine and endothelin-1. In
post-cardiopulmonary bypass kidneys at 24 hrs there was persistent hypoxia at
the level of the outer medulla, cortical adenosine triphosphate depletion, and
evidence of proximal tubule epithelial cell stress manifest as phenotypic
change. There was no evidence of acute tubular necrosis. Administration of
endothelin A RA to cardiopulmonary bypass pigs reversed endothelial
dysfunction, regional hypoxia, inflammation, and tubular changes.
Conclusion: In this model, post-cardiopulmonary bypass acute kidney injury
is associated with endothelial dysfunction, regional tissue hypoxia, and
proximal tubular epithelial cell stress but not acute tubular necrosis.
Antagonism of the endothelin-1 A receptor reversed these changes and may
represent a therapeutic target for the prevention of post-cardiac surgery acute
kidney injury
N ° 34 Ann Thorac Surg 2011; 92: 2168
–76
Phosphodiesterase-5 Inhibition Prevents Postcardiopulmonary
Bypass Acute Kidney Injury in Swine
Nishith N. Patel, MRCS, Hua Lin, MS,
Tibor Toth, MD, MRCPath, Ceri Jones, BS, Paramita Ray, FRCA, Gavin I. Welsh,
PhD, Simon C. Satchell, PhD, MRCP, Philippa Sleeman, BS, Gianni D. Angelini,
MD, FRCS, and Gavin J. Murphy, MD, FRCS
Background. Acute kidney
injury after cardiac surgery is common, has no effective treatments, and is
associated with adverse outcomes. The aim of this study was to determine
whether administration of the phosphodiesterase-5 inhibitor sildenafil citrate
(SDF) would prevent the development of post–cardiopulmonary bypass (CPB acute
kidney injury in swine.
Methods. Adult pigs (n= 8 per group) were
randomized to undergo sham procedure, CPB, or CPB plus administration of SDF,
with recovery and reassessment at 24 hours.
Results. Cardiopulmonary bypass
resulted in a significant reduction in creatinine clearance relative to sham
pigs (mean difference CPB versus sham, -47.9 mL/min; 95% confidence interval
[CI]: -93.7 to -2.2; p = 0.039). This was prevented by the administration of
SDF during CPB (mean difference CPB+SDF versus CPB, +55.6 mL/min; 95% CI: +6.5
to +104.7; p = 0.024). Cardiopulmonary bypass also resulted in a significant
rise in the urinary biomarker interleukin-18 compared with sham procedures
(mean difference 209.3 pg/mL; 95% CI: 120.6 to 298.1; p< 0.001) that was
prevented by SDF administration. Post-CPB kidney injury was associated with
vascular endothelial injury and dysfunction, reduced nitric oxide
bioavailability, medullary hypoxia, cortical adenosine triphosphate depletion,
inflammation, and evidence of proximal tubule epithelial cell stress manifest
as phenotypic change. Administration of SDF to CPB pigs preserved nitric oxide
bioavailability and prevented endothelial dysfunction, regional hypoxia,
inflammation, and tubular changes.
Conclusions. In this model,
phosphodiesterase-5 inhibition using SDF prevented post-CPB acute kidney injury
by the preservation of nitric oxide bioavailability, and warrants evaluation as
a renoprotective agent in clinical trials.
N ° 33
Medimond 2012 NX23 C0002 407-415
A new plastic self-expanding
cannula for central insertion
Abdel-Sayed S, Favre J, von Segesser
LK
A new plastic self expanding cannula is designed to fit with all
sizes of adult right atrium and vena cava(<34F). AN in vitro circuit was
set-up with silicone tubing between the test cannula encased in amovable
reservoir, and a static reservoir. At 90 cm height differential, the flow
values were 8.88±0.05 l/min as compared to 8.05±0.05 l/min for a typical 32/42
F two stage cannula. Despite the 38% smaller access orifice, the new
self-expanding plastic cannula outperforms the typical two stage
cannulas.
N ° 32 Kardiotechnik 2011; 4:
111-113
Erfahrungen mit der Smartcanula® zur venösen Drainage im
Langzeiteinsatz
Straub A, Schnu W, Quinz H, Oertel F, Beyer M
The
Smartcanula® was used for venous cannulation in 26 ECMO/ECLS runs for up to 17
days. In addition the Smartcanula® was used without oxygenator in two cases for
right ventricular assist (RVAD) with the Centrimag® pump. The experience with
the Smartcanula® was very positive in all patients. Pump flows of more than 5
l/min were reached without problem and maintained over prolonged periods. No
air-leak or thromboses were observed, and there were no technical
complications. Insertion and removal of the Smartcanula® was easy.
N ° 31 Perfusion 2011 ; 26 : 271-275
No prototype of
femoral arterial Smartcanula® with anterograde and retrograde flow
Berdajs
D, Ferrari E, MIchalis A, Burki M, Pieterse CW, Horisberger J, von Segesser
LK
A modified, bidirectional arterial Smartcanula® (18F, 130mm long)
was compared to aretrograde rectilinear percutaneous cannula (19F) with an
antegrade 8F shunt in bovine experiments (67.6±5.1 kg). The modified,
bidirectional, arterial Smartcanula® provided up to 50% superior antegrade flow
as compared to the traditional method relying on a retrograde cannula with an
antegrade shunt.
N ° 30 Interactive CardioVascular
and Thoracic Surgery 13 (2011) 591-596
The new advanced membrane
gas exchanger
Denis A. Berdajs*, Eleonora de Stefano, Dominique Delay,
Enrico Ferrari, Judith Horisberger, Quntin Ditmar, Ludwig K. von
Segesser
Current membrane oxygenators are constructed for patients
with a body surface under 2.2 m2. If the body surface exceeds 2.5 m2,
com¬mercially available devices may not allow adequate oxygenation during
cardiopulmonary bypass. To address this, a hollow-fiber oxygenator with an
enlarged contact surface of 1.81 m2 was tested. In an experimental set-up, six
calves of mean weight 85.4±3 kg were connected to cardiopulmonary bypass. They
were randomly assigned to a standard oxygenator (n=3; ADMIRAL, Euroset, Medola,
Italy) with a surface of 1.35 m2 or to an enlarged surface oxygenator (n=3;
AMG, Euroset). Blood samples were taken before bypass, after 10 min on bypass,
and after 1, 2, 5 and 6 h of perfusion. Analysis of variance was used for
repeated measurements. The mean flow rate was 6.5 l/min for 6 h. The total
oxygen transfer at 6 h was significantly higher in the high-surface group
(P<0.05). Blood trauma, evaluated by plasma hemoglobin and lactate
dehydrogenase levels, did not detect any significant hemolysis. Thrombocytes
and white blood cell count profiles showed no significant dif¬ferences between
the two groups at 6 h of perfusion (P=0.06 and 0.80, respectively). At the end
of testing, no clot deposition was found in the oxygenator, and there was no
evidence of peripheral emboli. The results suggest that the new oxygenator
allows very good gas transfer and may be used for patients with a large body
surface area.
N ° 29 Ter verkrijging van de graad
van doctor aan de Universiteit Maastricht, op gezag van de Rector Magnificus,
Prof. mr. G.P.M.F. Mols, volgens het besluit van het College van Decanen, in
het openbaar te verdedigen op woensdag 23 juni 2010 om 14:00 uur
To
drain or not to drain: Quantification of drainable intravascular venous volume
during extracorporeal life support
Antoine B. Simons
CONTENT OF
THIS THESIS
Previous work has shown, that patient filling is a fundamental
ingredient for successful operation of extracorporeal life support (ELS). This
thesis focuses on the interaction of the support system and the patient’s
circulation with respect to patient filling, and in addition highlights
hardware components used in extracorporeal circulation. Several references to
the Smartcanula® are made throughout this work.
Chapter 2 presents a
possible method to detect and reverse venous collapse resulting of low filling
during extracorporeal life support, and uses in vitro and animal experimental
data providing evidence for the rationale.
Chapter 3 illustrates the impact
of tip design of different venous cannulae for central cannulation on drainage
performance during obstruction of the inlet. A mock circulation was used to
induce vessel collapse resulting of excessive drainage with insufficient
filling.
Chapter 4 describes a clinical investigation of a measurement
method to assess volume available for drainage during the application of
minimized extracorporeal bypass systems. Luxation of the heart during coronary
artery bypass surgery was used to change volume that can be potentially drained
by the minimized extracorporeal circuit, and acted as a model for decreased
circulatory filling. Data from transesophageal echocardiography were used to
verify the impact of luxation on drainable volume.
Chapter 5 shows proof of
principle for a reserve-driven pump control for extracorporeal life support,
and presents animal experimental data in which the controller is tested during
an acute condition of low filling.
Chapter 6 presents a case report in which
a new approach for the quantitative assessment of cardiac load-responsiveness
is introduced, and discusses its potential for assisting future weaning from
extracorporeal life support.
Chapter 7 discusses a new pulsatile
centrifugal blood pump described in literature and its potential for
application in minimized bypass circuits as used in extracorporeal life support
(letter in response to an original publication).
Chapter 8 offers a general
discussion of the individual chapters and major findings, and provides a basis
for future research on extracorporeal life support.
N ° 28 CardioVascular and Thoracic Surgery 10 (2010)
873–876
Self-expanding mini-cannula for remote perfusion with
pediatric scenarios
Denis A. Berdajs, Enrico Bernandi, Marco Burki, Michel
Hurni, Piergiorgo Tozzi, Judit Horisberger, Ludwig K. von Segesser
The aim of this report is to address the benefits of the minimal invasive
venous drainage in a pediatric cardio surgical scenario. Juvenilebovine
experiments (67.4"11 kg) were performed. The right atrium was cannulated in a
trans-jugular way by using the self-expandable (Smart Stat, 12y20F, 430 mm)
venous cannula (Smartcannula_ LLC, Lausanne, Switzerland) vs. a 14F 250 mm
(Polystan Lighthouse) standard pediatric venous cannula. Establishing the
cardiopulmonary bypass (CPB), the blood flows were assessed for 20 mmHg, 30
mmHg and 40 mmHg of driving pressure. Venous drainage (flow in lymin) at 20
mmHg, 30 mmHg, and 40 mmHg drainage load was 0.26"0.1, 0.35"0.2 and 0.28"0.08
for the 14F standard vs. 1.31"0.22, 1.35"0.24 and 1.9"0.2 for the Smart Stat
12y20F cannula. The 43 cm self-expanding 12y20F Smartcannula_ outperforms the
14F standard cannula. The results described herein allow us to conclude that
usage of the selfexpanding Smartcannula_ also in the pediatric patients
improves the flow and the drainage capacity, avoiding the insufficient and
excessive drainage. We believe that similar results may be expected in the
clinical settings.
N ° 27 Journal of Cardio-thoracic
Surgery 36 (2009) 665—669
Superior flow for bridge to life with
self-expanding venous cannulas
Ludwig K. von Segesser, Martens Kalejs,
Enrico Ferrari, Sandra Bommeli, Olaf Maunz, Judith Horisberger, Piergiorgio
Tozzi
Background: Recently, a compact cardiopulmonary support (CPS)
system designed for quick set-up for example, during emergency cannulation, has
been introduced. Traditional rectilinear percutaneous cannulas are standard for
remote vascular access with the original design. The present study was designed
to assess the potential of performance increase by the introduction of
next-generation, self-expanding venous cannulas, which can take advantage of
the luminal width of the venous vasculature despite a relatively small access
orifice.
Methods: Veno-arterial bypass was established in three bovine
experiments (69 ± 10 kg). The LifebridgeW (Lifebridge GmbH, Munich, Germany)
system was connected to the right atrium in a trans-jugular fashion with
various venous cannulas; and the oxygenated blood was returned through the
carotid artery with a 17 F percutaneous cannula. Two different venous cannulas
were studied, and the correlation between the centrifugal pump speed (1500—3900
RPM), flow and the required negative pressure on the venous side was
established: (A) Biomedicus 19 F (Medtronic, Tolochenaz, Switzerland); (B)
Smart canula 18 F/36 F (Smartcanula LLC, Lausanne, Switzerland).
Results:
At 1500 RPM, the blood flow was 0.44 ± 0.26 l min-1 for the 19 F rectilinear
cannula versus 0.73 ± 0.34 l min-1 for the 18/36 F self-expanding cannula. At
2500 RPM the blood flow was 1.63 ± 0.62 l min-1 for the 19 F rectilinear
cannula versus 2.13 ± 0.34 l min-1 for the 18/36 F self-expanding cannula. At
3500 RPM, the blood flow was 2.78 ± 0.47 l min-1 for the 19 F rectilinear
cannula versus 3.64 ± 0.39 l min-1 for the 18/36 F self-expanding cannula (
p< 0.01 for 18/36 F vs 19 F). At 1500 RPM, the venous line pressure was 18 _
8 mmHg for the 19 F rectilinear cannula versus 19 _ 5 mmHg for the 18/36 F
selfexpanding cannula. At 2500 RPM the venous line pressure accounted for -22 ±
32 mmHg for the 19 F rectilinear cannula versus 2 ± 5 mmHg for the 18/36 F
self-expanding cannula. At 3500 RPM, the venous line pressure was -112 ± 42
mmHg for the rectilinear cannula versus 28 ± 7 mmHg for the 18/36 F
self-expanding cannula ( p< 0.01 for 18 F/36 F vs 19 F).
Conclusions:
The negative pressure required to achieve adequate venous drainage with the
self-expanding venous cannula accounts for approximately 31% of the pressure
necessary with the 19 F rectilinear cannula. In addition, a pump flow of more
than 4 l min_1 can be achieved with the self-expanding design and a
well-accepted negative inlet pressure for minimal blood trauma of less than 50
mmHg.
N ° 26 Interact CardioVasc Thorac Surg 2009;
8 Suppl 1: S87 Full paper link
Total cardiac unloading without
augmentation for beating heart LVAD implantation
E. Ferrari, P. Tozzi, S.
Bommeli, D. Delay, L. K. von Segesser
Trans-femoral venous smart
cannulation of the caval axis provides total unloading of the heart, thus
allowing for beating heart trans-apical cannulation for LVAD implantation:
calculated target flow was 4.54±0.26 l/min and achieved flow accounted for
5.43±0.55 l/min (119.6% of target).
N ° 25 Interact
CardioVasc Thorac Surg 2009; 8 Suppl 1: S54 Full paper link
Self expanding arterial cannula
for cardiopulmonary bypass: hemodynamic performance in an animal model
S.
Bommeli, E. Ferrari, E.Bernadini, L. K. von Segesser
This
experimental study shows two very interesting findings:
A) trans-jugular
venous smart cannulation allows to generate flows up top 6 l/min in bovine with
a mean bodyweight of 61.7±1.5 kg without augmentation
B) up to 6 l/min can
be returned to the animal through a 15F orifice using an arterial smart canula
with acceptable pressure gradients.
N ° 24
Perfusionist 2009; 33: 9-10 Full paper link
Venous drainage is key for CPB
L. K. von Segesser
The importance of venous drainage is often
underestimated during cardiopulmonary bypass. At typical flow rates for adult
patients of 4 I/min, even a venous reservoir level of 2.5 litres provides
sufficient volume to maintain flow for just about 30 seconds (= 2 litres) if
venous drainage is interrupted for some reason (eg venous line collapse, air
lock etc). However, for a reservoir level of 500 ml at the time of venous
drainage shut-down, the remaining time for action is close to zero. Hence, the
quality of the blood inflow into the pump-oxygenator is of prime importance,
and it has been well demonstrated the self-expanding venous smart
canula ® allows for significant improvement of the
latter.
N ° 23 European Journal for Cardiothoracic
Surgery. 2008;34:635-40 Abstract link
Routine use of self-expanding venous
cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive
cases
L. K. von Segesser, E. Ferrari, D. Delay, O. Maunz, J. Horisberger, P.
Tozzi
A prospective study was realized in 100 unselected consecutive
patients undergoing open-heart surgery with either remote or central smart
venous cannulation. The study focuses on the 76 consecutive adult patients
(mean age 59.2+/-17.3 years; 60 males, 16 females) undergoing surgical
procedures with total cardiopulmonary bypass for either valve procedures (42/76
patients=55.3%), ascending aorta and arch repair (20/76 patients=26.3%),
coronary artery revascularization (13/76 patients=17.1%) or other procedures
(11/76 patients=14.5%) with 14/76 patients (18.4%) undergoing redo surgery and
6/76 patients (7.9%) undergoing small access surgery. Full or more than target
flow was achieved in 97% of the patients studied undergoing CPB with
self-expanding venous cannulas and gravity drainage. Remote venous cannulation
with self-expanding cannulas provides similar flows as central cannulation.
Augmentation of venous return is no longer necessary.
N ° 22 Interactive CardioVascular and Thoracic Surgery. 2008; 7:1096-100
Full paper link
Temporary caval stenting improves
venous drainage during cardiopulmonary bypass
L. K. von Segesser G.
Siniscalch, K. Kang, O. Maunz, J. Horisberger, E. Ferrari, D. Delay, P.
Tozzi
Temporary caval stenting was realized in bovine experiments
(65+/-6 kg) by the means of self-expanding (18F for insertion, 36F in situ)
venous cannulas (Smartcanula LLC, Lausanne, Switzerland) with various lengths:
43 cm, 53 cm, 63 cm versus a standard 28F wire armed cannula in trans-jugular
fashion and maximal blood flows were assessed. The 43 cm self-expanding 36F
smartcanula outperforms the 28F standard wire armed cannula at low drainage
pressures and without augmentation. Temporary caval stenting with long
self-expanding venous cannulas provides even better drainage (+51%).
N ° 21 The Thoracic and Cardiovascular Surgeon 2008; 56:
337-41 Abstract link
A simple way to decompress the left
ventricle during veno-arterial bypass
L. K. von Segesser, W. Dembitsky, E.
Ferrari, D. Delay, J. Horisberger, P. Tozzi
Venoarterial bypass was
established in the experimental setting and cardiogenic shock was simulated
with ventricular fibrillation induced by an external stimulator. Left
ventricular decompression was achieved by switching to transfemoral drainage of
the pulmonary artery with a long self-expanding cannula. Remote drainage of the
pulmonary artery during venoarterial bypass allowed for effective decompression
of the left ventricle and provided superior hemodynamics.
N ° 20 Perfusion. 2007 Nov; 22: 411-6 Abstract link
New bench test for venous cannula
performance assessment
S. Abdel-Sayed, J. Favre, J. Horisberger, S. Taub, D.
Hayoz, L. K. von Segesser
Cannula design is of prime importance for
venous drainage during cardiopulmonary bypass (CPB). To evaluate cannulas
intended for CPB, an in vitro circuit was set up with silicone tubing between
the test cannula encased in a movable preload reservoir and another static
reservoir. Out of five cannulas tested, the Smartcanula outperforms the other
commercially available cannulas. The mean (DeltaP/Q) values were 3.3 +/- 0.08,
4.07 +/- 0.08, 5.58 +/- 0.10, 5.74 +/- 0.15, and 6.45 +/- 0.15 for Smart,
Medtronic, Edwards, Sarns, and Gambro cannulas, respectively (two-way ANOVA, p
< 0.0001). In conclusion, the present assay allows discrimination between
different forms of cannula with high or low lumen resistance.
N ° 19 Innovations 2006; 4: 213-4 Abstract link
Selfexpanding Cannulas For Combined
Use With Valved Stent Based Interventions. Superior Cardiopulmonary Flows In
Small Vessels - A Smarter Choice
C. Huber, G. Murphy, I. Mallabiabarrena, I.
Seigneul, M. Augstburger, G. Mucciolo, D. Jegger, J. Horisberger, S. Taub, L.
K. von Segesser
The smart canula
®was able to sustain significantly (p< 0.0001)
higher CPB flows of 3.9±0.7L/min with a mean arterial pressure of 74.7±20.7mmHg
compared to 2.8±1.5L/min of flow for the dlp cannula with a MAP of
71.3±19.9mmHg. Native macroscopic inspection and Evans blue vital staining as
well as histological analysis of various jugular vein segments confirmed
absence of endothelial damage.
N ° 18 Multimedia
Manual for Cardiothoracic Surgery 2006; doi:10.1510/mmcts.2005.001610
Full paper link
Peripheral cannulation for
cardiopulmonary bypass
L. K. von Segesser
Although most open
heart procedures are nowadays realized with central cannulation, there is
renewed interest in remote cannulation through the femoral, iliac, axillary,
subclavian and jugular vessels. Remote cannulation is not only of interest in
hemodynamically unstable patients who can be put on cardiopulmonary bypass in
local anesthesia, and stabilized prior to intubation, but also for complex
procedures like replacement of the thoracoabdominal aorta, acute type A aortic
dissections, complex redo open heart surgery, extracorporeal membrane
oxygenation, and more recently, small access open heart surgery, robotic
surgery, and others. Venous canulation with self-expanding smart canulase
allows for full flow with gravity drainage and does not require adjuncts for
augmentation.
N ° 17 European Journal of
Cardio-thoracic Surgery 2006; 29: 525-529 Abstract link
A novel technique using
echocardiography to evaluate venous cannula performance perioperatively in CPB
cardiac surgery
D. Jegger, P-G. Chassot, M-A. Bernath, J. Horisberger, P.
Gersbach, P. Tozzi, D. Delay, L. K. von Segesser
An epicardial
echocardiography probe was placed over the venous smart canula
® or a control two-stage cannula during open heart
surgery with CPB and central cannulation (right atrium to aorta) and a Doppler
image was obtained. The main findings of this study include superior blood flow
for the venous smart canula ® despite a
smaller access aperture and lower pressure drop as compared to classic two
stage venous cannulae. There was no difference between groups with regard to
blood trauma.
N ° 16 The Heart Surgery Forum 2005;
8: 241-5 Abstract link
The smart canula
®: A new tool for remote access perfusion in limited
access cardiac surgery
L. K. von Segesser, D. Jegger, G. Mucciolo, P. Tozzi,
A. Mucciolo, D. Delay, I. Mallabiabarrena, J. Horisberger
Smart canula ® performance was assessed in a
small series of patients (76 ± 17 kg) undergoing ascending aortic redo
procedures. The calculated target pump flow (2.4 L/min/m2)in these patients was
4.42 ± 61 L/ min. Mean pump flow achieved during cardiopulmonary bypass was
4.84 ± 87 L/min or 110% of the target. Reduced atrial chatter, kink resistance
in situ, and improved blood drainage despite smaller access orifice size, are
the most striking advantages of this new device.
N
° 15 Swiss Medical Weekly 2005; 136: 235-7 Full paper link
Hepato-atrial anastomosis, the
"other Senning operation" for treatment of Budd-Chiari syndrome
D. Delay, C.
Lardi, A. Jaussi, L. K. von Segesser
The smart canula
® was used in femoral position for repair of an
Intra-hepatic vena cava occlusion. Trans-atrial resection and hepato-atrial
anastomosis was realized in open fashion (no snears). Full pump flow and
excellent visibility intra-hepatic and intracaval visibility were achieved
throughout the procedure.
N ° 14 Artificial Organs
2004 ; 28 : 649-54
Vascular access for cardiopulmonary bypass
procedures
D. Jegger, J. Horisberger, Y Boone, I. Seigneuil, M. Jachertz,
Holzmann, L. K. von Segesser
Not only catheter diameter , but also
catheter drainage hole surface and the catheter diameter to the patients veins
diameter ratio correlate with flow. The smart canula
® maximizes hole surface area and minimizes wall
thickness in order to improve flow rate and vascular access to the
patient.
N ° 13 Syllabus of Postgraduate Course on
Perfusion by the European Association for Cardio-thoracic Surgery, Leipzig
2004
Systemic venous return: Can we help Newton?
A. F. Corno
The limitations of current venous cannulae and related technologies for
augmentation of venous return are summarized. The smart canula
® allowing for adequate venous return with gravity
drainage alone outperforms traditional
approaches.
N ° 12 European Journal for
Cardio-thoracic Surgery 2004; 26: 219-20
Right atrial surgery with
un-snared inferior vena cava
A. F. Corno, J. Horisberger, D. Jegger, L. K.
von Segesser
Femoral cannulation with the smart canula
® allows for open right atrial surgery without snaring
the inferior vena cava. Despite full pump flow, the supra-hepatic veins can be
inspected in detail and cavo-atrial anastomoses or extra-cardiac tunnels for
Fontan completion can be realized with unmatched
comfort.
N ° 11 Business Briefings: Surgery
2003
A smart solution for cannulation bottleneck
L. K. von
Segesser
Flow-wise, the highest benefits with the smart
canula ® can be achieved by peripheral cannulation.
However, use of the smart canula ® is also
beneficial for central cannulation, where the access aperture can be reduced
from 50F or more to less than 30F without compromising pump flow.
N ° 10 Swiss Perfusion 2003; 12: 22-25 Full paper link
In vivo analysis of the
smart canula ® for assisted venous drainage
applications
D. Jegger, J. Horisberger, Y. Boone, M. Jachertz, I. Seigneul,
M. Augstburger, L. K. von Segesser
For assisted venous drainage
applications, the smart canula
®outperforms standard and percutaneous type venous
cannulas. The smart canula ® in combination
with gravity drainage achieves the same flow as standard and percutaneous
cannulas in combination with a centrifugal pump in the venous line. Hence, with
the smart canula ®, centrifugal pump
augmentation is not necessay.
N ° 09 Perfusion 2003
; 18 : 219-224
Miniaturization in cardiopulmonary bypass
L. K.
von Segesser, P. Tozzi, I. Mallbiabarrena, J. Horisberger, A. Corno
Miniaturization is key to further reduction of the priming volumes in
cardiopulmonary bypass. This report provides an up-date of already commercially
availableand up-coming low-prime perfusion devices like the smart
canula ® with its revolutionary cannulation
concept.
N ° 08 Perfusion 2003; 18:
61-65Abstract link
A prototype paediatric venous
cannula with shape change in situ
D. Jegger, A. F. Corno, A Mucciolo, G.
Mucciolo, Y. Boone, J. Horisberger, I. Seigneul, M. Jachertz, L. K. von
Segesser
Bench tests simulating a collapsible vein of a pediatric
cannula based on the smart canula
®principle shows superior flow if compared to classic
single stage cannulas typically used for paediatric cardiopulmonary
bypass.
N° 07 The Annals of Thoracic Surgery 2002;
74: S1330-3 Abstract link
A new expandable venous cannula for
minimal acces heart surgery
X Mueller, H tevaearai, D. Jegger, J.
Horisberger, G. Mucciolo, L. K. von Segesser
In vivo evaluation of
the smart canula ® in comparison to
typical percutaneous venous canulas shows 34 % more flow for a 27 F access
aperture, 42 % more flow for a 25 F access aperture and 53 % more flow for a
21% access aperture.
N ° 06 The International
Journal of Artificial Organs 2002; 25: 672
A new expandable
pediatric venous cannula which changes shape in situ
D. Jegger, X. Mueller,
G. Mucciolo, Y. Boone, J. Horisberger, L. K. von Segesser
In vitro
evaluation of a new pediatric cannula based on the smart canula
® principle shows superior flow if compared to standard
pediatric cannulas.
N ° 05 ASAJO Journal 2002; 48:
132
The smart canula: a new concept for improved venous drainage
with no impact on blood cell integrity
X. Mueller, H. Tevaearai, D. Jegger,
J. Horisberger, G. Mucciolo, L. K. von Segesser
The
smart canula ® with its innovative design
for improved drainage has no impact on formed blood elements when compared with
standard single stage cannulas.
N° 04 The
International Journal of Artificial Organs 2002; 25: 136-40
A new
expandable cannula to increase venous return during peripheral access
cardiopulmonary bypass surgery
D. Jegger, X. Mueller, G. Mucciolo, Y. Boone,
I. Seigneul, J. Horisberger, L. K. von Segesser
Benchtests
simulating drainage of a collapsible vein showed superior performance for the
smart canula ® as compared to standard
cannulas.
N ° 03 Interactive Cardiovascular and
Thoracic Surgery 2002; 1: 23-7 Full paper link
Optimized venous return with a
self expanding cannula: From computational fluid dynamics to clinical
application
X Mueller, I Mallabiabarena, G Mucciolo, LK von Segesser
Computational fluid dynamics, animal experiments, and first clinical use
confirm superior performance of smart canula
®: includes discussion.
N°
02 Cardiovascular Engineering 2002; 7: 23-4
Optimisation of venous
return with a self-expandable canula
X Mueller, D Jegger, J Horisberger, G
Mucciolo, A Mucciolo, LK von Segesser
Preliminary experimental
evaluation in vivo showed better performance for smart canula
®.
N° 01 The International
Journal of Artificial Organs 2001; 24: 532
A new expandable canula
to increase venous return during peripheral access in cpb surgery
D Jegger,
X Mueller, G Mucciolo, Y Boone, I Seigneul, J Horisberger, LK von
Segesser
Benchtests showed higher flows for the smart
canula ® as compared to standard
cannulas.
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- Literature
