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 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+/-0.6l/min, p=0.5). KAVD patients had a lower mean S(v)O(2) and a higher desaturation index than GSD patients (69.5+/-4.6 vs 76.1+/-5.4mmHg, 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.