title: Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study.
abstract: OBJECTIVE
  In this prospective, randomized study, we investigate the potential advantages of vacuum-assisted venous drainage (VAVD), compared to gravitational drainage (GD), in patients undergoing first-time coronary artery bypass graft (CABG) surgery, concerning biochemical markers of organ and blood cell damage.
  
  
  METHODS
  Seventy-two consecutive patients were randomized into two groups ['Vacuum' (VAVD) n=36; 'Not vacuum' (GD) n=36]. VAVD was achieved using a wall vacuum source and with a suction regulator connected to the vent port of the hardshell venous reservoir. In the VAVD group, we used 28-French venous cannulas, and 36-French in the GD group. In the VAVD group, we measured arterial perfusion flow (APF) and the venous reservoir volume (VRV) with and without vacuum application just after starting extracorporeal circulation (ECC). Six blood samples were drawn at different times before, during and after ECC. Routine blood tests were performed to evaluate hemolysis, and hepatic and renal function.
  
  
  RESULTS
  The two groups were similar in terms of preoperative and operative characteristics. There were no significant differences in biochemical markers of organ function or hemolysis between the two groups. In the VAVD patients, platelet count was higher at 24 h after the end of the operation (VAVD 151.77+/-50.28 microl versus Not vacuum 124.93+/-41.60 microl, p=0.028). With the narrower venous cannulas (28-French), only VAVD achieved a satisfactory APF (VAVD 2.35+/-0.38 l/min/m2 versus GD 1.88+/-0.27 l/min/m2, p=0.002), with a larger VRV (VAVD 1091.67+/-421 ml versus GD 808.33+/-284.31 ml, p=0.025).
  
  
  CONCLUSIONS
  Vacuum-assisted venous drainage is a technique comparable to gravitational drainage with regard to hemolysis and organ perfusion. It allows better perfusion flow and heart decompression with smaller venous cannulas. This study suggests reduced platelet consumption with VAVD.
authors.affiliation: Cardiac Surgery Department, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Massa, Italy. bevilacqua@ifc.pi.cnr.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Sacha
authors.initials: S
authors.lastname: Matteucci
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferrarini
authors.forename: Mirsad
authors.initials: M
authors.lastname: Kacila
authors.forename: Andrea
authors.initials: A
authors.lastname: Ripoli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Baroni
authors.forename: Domenico
authors.initials: D
authors.lastname: Mercogliano
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D002405:Catheterization, Central Venous / Q000379:methods* / Q000592:standards; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006112:Gravitation; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D014618:Vacuum
chemical_list: D015415:Biomarkers; D006454:Hemoglobins