Berthod J, Tevaearai H T, Mueller X M, Mabillard E, Von Segesser L K, Stumpe F
Service de chirurgie cardio-vasculaire, Hôpital de Sion, CHUV, Lausanne.
Rev Med Suisse Romande. 2000 Jul;120(7):569-72.
"Minimal invasive" surgical closure of an atrial septal defect (ASD) is performed under femoro-femoral CPB, the superior vena cava being (IVC) drained by a supplementary cannula placed directly through the thoracic opening. We present a new technique where both vena cavae are drained by a single 2 stage femoral cannula.
The cannula is introduced through the femoral vein and its distal holes are directed into the superior vena cava (SVC) while the proximal holes are maintained into the IVC. A centrifugal pump is placed on the venous line between the cannula and the venous reservoir in order to improve the venous return. Both IVC and SVC are clamped around the cannula to isolate the right atrium before opening it and repairing the ASD.
We recently operated on a 60 years old man using this technique. Passive venous drainage was 2.6 l/min whereas the perfusion theoretical flow was 5.4 l/min. But adding the centrifugal pump increased the flow to 5.4 l/min which ensured an optimal perfusion flow. CPB time was 38 minutes and operative time was 140 minutes. There were no complications and the patient returned home at day 5 following the operation.
Using a single venous cannula for drainage of both vena cavae simplifies the technique and therefore contributes to the development of "minimally invasive" cardiac surgery.
房间隔缺损（ASD）的“微创”手术闭合是在股-股体外循环下进行的，上腔静脉由直接经胸廓开孔置入的辅助插管引流。我们提出一种新技术，即通过一根双阶段股静脉插管引流上下腔静脉。
插管经股静脉置入，其远端孔朝向头臂干静脉，近端孔位于下腔静脉。在插管与静脉储血器之间的静脉管路上放置一台离心泵，以改善静脉回流。在下腔静脉和头臂干静脉处围绕插管进行钳夹，在打开右心房并修复房间隔缺损之前隔离右心房。
我们最近使用该技术为一名60岁男性实施了手术。被动静脉引流为2.6升/分钟，而灌注理论流量为5.4升/分钟。但添加离心泵后流量增加到5.4升/分钟，确保了最佳灌注流量。体外循环时间为38分钟，手术时间为140分钟。无并发症发生，患者术后第5天出院。
使用单一静脉插管引流上下腔静脉简化了技术，因此有助于“微创”心脏手术的发展。
