Vandewiele Korneel, De Somer Filip, Vandenheuvel Michael, Verdonck Pascal, Bové Thierry
Department of Perfusion, Ghent University Hospital, Ghent, Belgium.
Department of Cardiac Anaesthesia, Ghent University Hospital, Ghent, Belgium.
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6). doi: 10.1093/icvts/ivaf127.
Peripheral cannula selection in minimally invasive cardiac surgery (MICS) is crucial, as venous drainage limitations during cardiopulmonary bypass (CPB) can impair end-organ perfusion and overall outcomes. This study evaluates the in vivo venous drainage efficiency of different peripheral venous cannulas for adult MICS by applying dynamic similarity (DS) prediction formulas.
This observational study included 75 adult MICS patients with use of single peripheral venous cannulation from January 2017 to June 2023. The analysis included cannulas Bio-Medicus Multi XL Life Support, Nextgen Bicaval and Smart cannulas. Cannula performance was assessed by comparing predicted pressures with in vivo measurements.
A total of 278, 314 and 264 measurements were recorded for the Multi, Next and Smart cannulas, respectively. No significant demographic differences were found between groups. Lin's concordance correlation coefficients for agreement between predicted and measured pressures were >0.95 for the Multi and Next cannulas but substantially lower for the Smart cannula (0.80). Bland-Altman analysis showed a mean bias of -1.09 mmHg for the Multi, -0.15 mmHg for the Next and 3.68 mmHg for the Smart cannula, with the latter exceeding the ±12.5 mmHg limits of agreement.
DS-based predictions revealed significant performance variability among peripheral venous cannula types. The in vivo performance was adequately predicted for the Multi and Next cannulas but not for the Smart cannula, underscoring the need for real-life evaluations and performance monitoring during CPB. Incorporating dynamic performance assessments into clinical decision-making might optimize venous drainage and patient outcomes.
在微创心脏手术（MICS）中，外周插管的选择至关重要，因为体外循环（CPB）期间的静脉引流限制可能会损害终末器官灌注和整体预后。本研究通过应用动态相似性（DS）预测公式，评估不同外周静脉插管用于成人MICS的体内静脉引流效率。
这项观察性研究纳入了2017年1月至2023年6月期间使用单根外周静脉插管的75例成人MICS患者。分析包括Bio-Medicus Multi XL Life Support、Nextgen Bicaval和Smart插管。通过将预测压力与体内测量值进行比较来评估插管性能。
分别记录了Multi、Next和Smart插管的278次、314次和264次测量。各组之间未发现显著的人口统计学差异。Multi和Next插管预测压力与测量压力之间的一致性相关系数>0.95，但Smart插管的一致性相关系数则低得多（0.80）。Bland-Altman分析显示，Multi插管的平均偏差为-1.09 mmHg，Next插管为-0.15 mmHg，Smart插管为3.68 mmHg，后者超出了±12.5 mmHg的一致性界限。
基于DS的预测显示，外周静脉插管类型之间的性能存在显著差异。Multi和Next插管的体内性能得到了充分预测，但Smart插管则不然，这突出了在CPB期间进行实际评估和性能监测的必要性。将动态性能评估纳入临床决策可能会优化静脉引流和患者预后。
