eComment: Rationalizing the use of assisted venous drainage during minimally invasive valve surgery.

Nomenclature Historical Pages-1.80 m , AVD is unlikely to be required, and, therefore, 2 should not be routinely included in the CPB circuit unless required intraoperatively. This rationale would also have cost-saving implications. Our study also suffers a number of limitations. First, despite all data being prospectively recorded, it has been analysed retrospectively. Second, the patients were not randomised into either of the two groups. Third, the decision to use AVD was purely at the discretion of the surgeon and the clinical perfusionist, based on their assessment of the venous drainage, and thus a selection bias could exist. Finally, it is a relatively small study. Despite these limitations, we have observed that AVD is not essential in every patient who undergoes mAVR, and is more likely to be used in patients with a larger BSA. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. w4x Wang S, Undar A. Vacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass. Limitations using the vacuum-assisted venous drainage technique during cardiopulmonary bypass procedures. drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage. Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery. w9x DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Relative importance of venous and arterial resistance in controlling venous return and cardiac output. During minimally invasive valve surgery, a good exposure with a bloodless field is a prerequisite for the ease and success of the surgery. We would like to comment on the issue regarding the use of assisted venous drainage (AVD) raised by the authors w1x. AVD is an important tool available for cardiac surgeons to achieve a bloodless operating field and to empty the heart in order to perform the most important part of the valve surgery. Using direct cannulation of the right atrium might cause crowding of the operative field due to the presence of aortic, venous and venting cannulas as well as aortic-clamp and CO 2 line supply passing through the incision site. Additionally, due to the higher position of the venous cannula in the right atrium, it might need more negative pressure for AVD. Instead, cannulating the femoral vein with double-staged venous cannula (the Remote Access Perfusion Femoral Venousீ cannula, RAP FV; Estech Inc, USA) …