title: Performance increase in venous drainage for mini-invasive heart surgery: superiority of self-expanding cannulas.
abstract: OBJECTIVE
  Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices.
  
  
  METHODS
  To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used.
  
  
  RESULTS
  Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, -5.4, -15.9, -45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula.
  
  
  CONCLUSIONS
  Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.
authors.affiliation: From the *Cardiovascular Research, Department of Surgery, University Hospital - Centre Hospitalier Universitaire Vaudois; and †Laboratory for Movement Analysis, Swiss Federal Institute of Technology, Lausanne, Switzerland.
authors.forename: Mhedi
authors.initials: M
authors.lastname: Belkoniene
authors.forename: Saad
authors.initials: S
authors.lastname: Abdel-Sayed
authors.forename: Julien
authors.initials: J
authors.lastname: Favre
authors.forename: Ludwig-Karl
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D057785:Catheters; D004322:Drainage / Q000295:instrumentation*; D004867:Equipment Design; D019060:Minimally Invasive Surgical Procedures; D014680:Veins