Vacuum-assisted drainage in cardiopulmonary bypass:
               advantages and disadvantages

Carvalho Filho, Élio Barreto de; Marson, Fernando Augusto de Lima; Costa, Loredana Nilkenes Gomes da; Antunes, Nilson

doi:10.5935/1678-9741.20140029

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Brazilian Journal of Cardiovascular Surgery

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REVIEW ARTICLE • Rev Bras Cir Cardiovasc 29 (2) • Apr-Jun 2014 • https://doi.org/10.5935/1678-9741.20140029 copy

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages

Authorship SCIMAGO INSTITUTIONS RANKINGS

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

Cardiopulmonary Bypass; Review; Thoracic Surgery

Characteristics	Number of studies ^(references)
Reduction in transfusion	7 ^[⁸8. Fukuda W, Aoki C, Daitoku K, Fukuda I. Vacuum-assisted venous drainage in tricuspid valve re-replacement. Interact Cardiovasc Thoracic Surg. 2011;13(1)101-3. 9. Gregory SM, Kussman BD, Wagner JW, Boyle SL, Howe RJ, Pigula FA et al. Massive Air Embolism in a Fontan patient. J Extracorp Technol. 2011;43(2):79-83. 10. Petzina R, Ugander M, Gustafsson L, Engblom H, Sjögren J, Hetzer R, et al. Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging. J Thorac Cardiovasc Surg. 2007;133(5):1154-62. 11. Kadohama T, Akasaka N, Nagamine A, Nakanishi K, Kiyokawa K, Goh K, et al. Vacuum-assisted closure for pediatric post-sernotomy mediastinitis: are low negative pressures sufficient? An Thorac Surg. 2008;85(3):1094-6.^-¹²12. Conquest AM, Garofalo JH, Maziarz DM, Mendelson KG, Su Sun Y, Wooden WA, et al. Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds. J Surg Res. 2003;115(2):209-13.^,¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61.^,²¹21. Pappalardo F, Corno C, Franco A, GiardinaG, Scandroglio AM, Landoni G, et al. Reduction of hemodilution in small adults undergoing open heart surgery: a prospective randomized trial. Perfusion. 2007;22(5):317-22.^]
Reduction in hemodilutions	7 ^[⁹9. Gregory SM, Kussman BD, Wagner JW, Boyle SL, Howe RJ, Pigula FA et al. Massive Air Embolism in a Fontan patient. J Extracorp Technol. 2011;43(2):79-83.^,¹²12. Conquest AM, Garofalo JH, Maziarz DM, Mendelson KG, Su Sun Y, Wooden WA, et al. Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds. J Surg Res. 2003;115(2):209-13.^,¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61.^,²⁰20. Hayashi Y, Kagisaki K, Yamaguchi T, Sakaguchi T, Naka Y, Sawa Y, et al. Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. Eur J Cardiothorac Surg. 2001;20(3):621-6.^,²²22. Colangelo N, Torracca L, Lapenna E, Moriggia S, Crescenzi G, Alfieri O. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion. 2006;21(6):361-5.^]
Better operative field	2 ^[⁹9. Gregory SM, Kussman BD, Wagner JW, Boyle SL, Howe RJ, Pigula FA et al. Massive Air Embolism in a Fontan patient. J Extracorp Technol. 2011;43(2):79-83.^,²⁴24. Shin H, Yozu R, Maehara T, Matayoshi T, Morita M, Kawai Y, et al. Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery: its feasibility and effects on hemolysis. J Artif Organs 2000;24(6):450-3.^]
Non-significant hemolysis	7 ^[¹⁰10. Petzina R, Ugander M, Gustafsson L, Engblom H, Sjögren J, Hetzer R, et al. Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging. J Thorac Cardiovasc Surg. 2007;133(5):1154-62.^,¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61.^,¹⁹19. Nakanishi K, Shichijo T, Shinkawa Y, Takeuchi S, Nakai M, Kato G, et al. Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion. Eur J Cardiothorac Surg. 2001;20(2):233-8.^,²⁰20. Hayashi Y, Kagisaki K, Yamaguchi T, Sakaguchi T, Naka Y, Sawa Y, et al. Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. Eur J Cardiothorac Surg. 2001;20(3):621-6.^,²²22. Colangelo N, Torracca L, Lapenna E, Moriggia S, Crescenzi G, Alfieri O. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion. 2006;21(6):361-5.^,²⁶26. Cirri S, Negri L. Babbini M, Latis G, Khlat B, Tarelli G, et al. Haemolysis due to active venous drainage during cardiopulmonary bypass: comparison of two different techniques. Perfusion. 2001;16(4):313-8.^]
Reduction in postoperative complications	2 ^[¹⁰10. Petzina R, Ugander M, Gustafsson L, Engblom H, Sjögren J, Hetzer R, et al. Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging. J Thorac Cardiovasc Surg. 2007;133(5):1154-62.^,¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61.^]
Lower prime volume	₇ ^[ ¹⁰10. Petzina R, Ugander M, Gustafsson L, Engblom H, Sjögren J, Hetzer R, et al. Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging. J Thorac Cardiovasc Surg. 2007;133(5):1154-62. 11. Kadohama T, Akasaka N, Nagamine A, Nakanishi K, Kiyokawa K, Goh K, et al. Vacuum-assisted closure for pediatric post-sernotomy mediastinitis: are low negative pressures sufficient? An Thorac Surg. 2008;85(3):1094-6. ^- ¹²12. Conquest AM, Garofalo JH, Maziarz DM, Mendelson KG, Su Sun Y, Wooden WA, et al. Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds. J Surg Res. 2003;115(2):209-13. ^, ¹⁷17. Banbury MK, White JA, Blackstone EH, Cosgrove DM 3rd. Vacuum-assisted venous return reduces blood usage. J Thorac Cardiovasc Surg. 2003;126(3):680-7. ^, ¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61. ^, ²⁰20. Hayashi Y, Kagisaki K, Yamaguchi T, Sakaguchi T, Naka Y, Sawa Y, et al. Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. Eur J Cardiothorac Surg. 2001;20(3):621-6. ^, ²¹21. Pappalardo F, Corno C, Franco A, GiardinaG, Scandroglio AM, Landoni G, et al. Reduction of hemodilution in small adults undergoing open heart surgery: a prospective randomized trial. Perfusion. 2007;22(5):317-22. ^]
Smaller cannulas diameter	₄ ^[ ¹¹11. Kadohama T, Akasaka N, Nagamine A, Nakanishi K, Kiyokawa K, Goh K, et al. Vacuum-assisted closure for pediatric post-sernotomy mediastinitis: are low negative pressures sufficient? An Thorac Surg. 2008;85(3):1094-6. ^, ¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61. ^, ²⁰20. Hayashi Y, Kagisaki K, Yamaguchi T, Sakaguchi T, Naka Y, Sawa Y, et al. Clinical application of vacuum-assisted cardiopulmonary bypass with a pressure relief valve. Eur J Cardiothorac Surg. 2001;20(3):621-6. ^, ²⁴24. Shin H, Yozu R, Maehara T, Matayoshi T, Morita M, Kawai Y, et al. Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery: its feasibility and effects on hemolysis. J Artif Organs 2000;24(6):450-3. ^]
High risk	2 ^[¹³13. Lindstedt S, Malmsjö M, Ingemansson R. Blood flow changes in normal and ischemic myocardium during topically applied negative pressure. Ann Thorac Surg. 2007;84(2):568-73.^,³⁴34. Vandenburgh HH. Mechanical forces and their second messengers in stimulating cell growth in vitro. Am J Physiol. 1992;262(3 Pt 2):R350-5.^]
Limitations	3 ^[¹²12. Conquest AM, Garofalo JH, Maziarz DM, Mendelson KG, Su Sun Y, Wooden WA, et al. Hemodynamic effects of the vacuum-assisted closure device on open mediastinal wounds. J Surg Res. 2003;115(2):209-13.^,¹⁷17. Banbury MK, White JA, Blackstone EH, Cosgrove DM 3rd. Vacuum-assisted venous return reduces blood usage. J Thorac Cardiovasc Surg. 2003;126(3):680-7.^,¹⁹19. Nakanishi K, Shichijo T, Shinkawa Y, Takeuchi S, Nakai M, Kato G, et al. Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion. Eur J Cardiothorac Surg. 2001;20(2):233-8.^]
Air Embolism	5 ^[¹¹11. Kadohama T, Akasaka N, Nagamine A, Nakanishi K, Kiyokawa K, Goh K, et al. Vacuum-assisted closure for pediatric post-sernotomy mediastinitis: are low negative pressures sufficient? An Thorac Surg. 2008;85(3):1094-6.^,¹³13. Lindstedt S, Malmsjö M, Ingemansson R. Blood flow changes in normal and ischemic myocardium during topically applied negative pressure. Ann Thorac Surg. 2007;84(2):568-73.^,16^,¹⁸18. Bevilacqua S, Matteucci S, Ferrarini M, Kacila M, Ripoli A, Baroni A, et al. Biochemical evaluation of vacuum-assisted venous drainage: a randomized, prospective study. Perfusion. 2002;17(1):57-61.^,¹⁹19. Nakanishi K, Shichijo T, Shinkawa Y, Takeuchi S, Nakai M, Kato G, et al. Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion. Eur J Cardiothorac Surg. 2001;20(2):233-8.^]

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[1] Correspondence address: Fernando Augusto de Lima Marson, Unicamp - Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, SP, Brazil - Zip code: 13083-887. E-mail: fernandolimamarson@hotmail.com