Kinetic assisted venous drainage for orthotopic heart transplantation in patients under mechanical circulatory support: a double-edged sword.

Background: Heart transplantation in patients supported with ventricular assist devices (VADs) entails a high risk of injury at resternotomy. Prior femorofemoral bypass is the preferred approach in these patients, but poor venous drainage may restrict arterial flow rate. Patients and methods: We compared bypass parameters, transfusion requirements and postoperative outcome in 33 consecutive patients (40.4 12.2 years old, 28 men) assisted with the Thoratec W paracorporeal VAD (mean duration, 3.0 2.96 months) undergoing transplantation using either gravity siphon drainage (GSD, n = 16) or kinetic assisted venous drainage (KAVD, n = 17). Results: Cannulation technique, perfusion pressure, temperature and duration were similar between groups. There were no significant differences in arterial re-infusion flow rates (GSD, 3.6 0.7 vs KAVD, 3.8 0.6 l/min, p = 0.5). KAVD patients had a lower mean SvO2 and a higher desaturation index than GSD patients (69.5 4.6 vs 76.1 5.4 mmHg, p = 0.004; and 0.63 0.23 vs 0.25 0.63, p = 0.0001, respectively). Perioperative requirements in fresh frozen plasma and platelet transfusions were significantly higher in KAVD patients. However, there were no differences in postoperative patient outcome. Conclusion: Perceived benefits on venous return associated with KAVD do not necessarily translate into improved arterial re-infusion flow rates and should be weighed against the hazards of increased venous air aspiration and blood product requirements. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.