Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience.
BACKGROUND
Division of the sternum is primarily a blind procedure in reoperation and carries an increased risk of injury for major cardiac structures in the presence of adhesions between the posterior table and the heart.


METHODS
Two hundred patients were randomly divided into two groups. Cardiopulmonary bypass was established through the femoral artery and vein in group 1 (n = 100) patients before sternal reentry. Carpentier dual-stage femoral venous return cannula was used in all group 1 patients. Cardiopulmonary bypass was performed after sternal reentry in group 2 (n = 100) patients.


RESULTS
Six severe cardiac injuries developed in group 2. Cardiopulmonary bypass time was 93 +/- 9 minutes in group 1 and 71 +/- 11 minutes in group 2 (p = 0.011), and the operation time was 155 +/- 23 minutes in group 1 and 185 +/- 32 minutes in group 2 (p = 0.024). Inotropic therapy was required in 52 patients in group 1 and 76 patients in group 2 (p = 0.032). Average chest drainage was 450 +/- 135 mL in group 1 and 850 +/- 250 mL in group 2 (p < 0.001). Average fresh whole blood transfusion was 3.3 +/- 1.2 U in group 1 and 5.8 +/- 0.9 U in group 2 (p = 0.033). Average intensive care unit stay was 2.2 +/- 1.3 days in group 1 and 4.5 +/- 2.3 days in group 2 (p = 0.025). Average hospital stay was 7.3 +/- 2.4 days in group 1 and 9.1 +/- 3.1 days for group 2 (p = 0.011).


CONCLUSIONS
Cardiopulmonary bypass by bicaval Carpentier femoral venous cannula before resternotomy not only allows adequate cardiopulmonary bypass flow but also significantly reduces the risk of cardiac injury and catastrophic hemorrhage and allows safe reopening. Although this procedure increases cardiopulmonary bypass time, the operation time, bleeding, and blood transfusion requirement are significantly reduced.
Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey. ekural@gata.edu.tr
Erkan
E
Kuralay
Cengiz
C
Bolcal
Faruk
F
Cingoz
Celalettin
C
Günay
Vedat
V
Yildirim
Selim
S
Kilic
Ertugrul
E
Ozal
Ufuk
U
Demirkilic
Mehmet
M
Arslan
Harun
H
Tatar
D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D001026:Coronary Artery Bypass; D005260:Female; D006335:Heart Injuries / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013249:Sternum / Q000601:surgery
D002316:Cardiotonic Agents