title: Vacuum-assisted venous drainage does not increase the neurological risk.
abstract: BACKGROUND
  Vacuum-assisted venous drainage (VAVD) with negative pressure applied to integral sealed-hardshell venous reservoir facilitates valvular surgery through minimally invasive approaches. Despite concerns regarding air entrainment from the right atrium, cerebral microemboli of air and neurological complications, VAVD was used in patients who underwent valvular surgery throughout the last two years in our institution.
  
  
  METHODS
  We compared the rate of neurological complications in patients who underwent surgery with and without VAVD from June 1997 to July 2001. VAVD was added to solid venous reservoirs with membrane oxygenators and arterial filters. Clinical results were prospectively entered in our valve database and were used for the analysis.
  
  
  RESULTS
  Eight hundred twenty-two consecutive patients averaging 65 +/- 11 years of age underwent aortic, mitral and tricuspid valve replacements including 40 redos (40/822, 5%) and 265 associated CABG (265/822, 32%) with VAVD in 1999 to 2001 compared to 723 patients averaging 63 +/- 11 years of age (p = 0.01) who underwent the same procedures with 79 redos (79/723, 11%) and 177 CABG (177/723, 24%) without VAVD in 1997 to 1999. CPB time averaged 117 +/- 50 minutes in VAVD patients compared to 108 +/- 43 minutes in those without VAVD (p = 0.001). Thirty-day mortality averaged 5% (39/822) in patients with VAVD and 4% (30/723) in those without VAVD (p = 0.6). Seven patients of the VAVD group (7/822, 1%) and 11 patients without VAVD (11/723, 1.5%, p = 0.2) suffered from temporary or permanent neurological deficit.
  
  
  CONCLUSIONS
  VAVD is a useful adjunct to modern cardiopulmonary bypass systems. When used with appropriate care, VAVD does not appear to significantly increase air microemboli and is not associated with an increased neurological risk following valvular surgery.
authors.affiliation: Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada. carrier@icm.umontreal.ca
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: André
authors.initials: A
authors.lastname: Cyr
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
authors.forename: Yves
authors.initials: Y
authors.lastname: Hébert
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Nancy
authors.initials: N
authors.lastname: Poirier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D002170:Canada / Q000453:epidemiology; D002315:Cardiopulmonary Bypass; D004322:Drainage; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014618:Vacuum