Semin cardiothorac vasc anesth

Table 4.  Right Atrial Cannula, Estimated Flow Rates.

BSA

Size

Maximum 

Flow (L/min)

Model

Manufacturer

≤1.8 m

2

29/37 Fr

4.5

Thin-Flex Edwards Life 

Science

>1.8 m

2

 to 2.5 m

2

32/40 Fr

6.0

MC2

Medtronic

≥2.5 m

2

36/46 Fr

8.0

MC2

Medtronic

Table 5.  Femoral Venous Cannula, Estimated Flow Rates.

Size

Augmented Maximum 

Flow (L/min)

a

Model

Manufacturer

17 Fr

2.6

Bio-Medicus one piece Medtronic

19 Fr

3.5

Bio-Medicus one piece Medtronic

19 Fr

3.8

Bio-Medicus multistage Medtronic

21 Fr

4.0

Bio-Medicus one piece Medtronic

21 Fr

4.5

Bio-Medicus Multistage Medtronic

22 Fr

4.6

Remote Access 

Perfusion (RAP)

Sorin

25 Fr

5.2

Bio-Medicus Multistage Medtronic

23/25 Fr

5.2

RAP

Sorin

a

Approximate cardiopulmonary bypass flow with net (gravity + applied) negative 

pressure of −80 to −100 mm Hg.

 at UNIV MASSACHUSETTS BOSTON on August 28, 2014

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Shann and Melnitchouk 

151

Group Italia; Mirandola, Italy). Figure 2 illustrates the surgi-

cal setup with cardioplegia/aortic root vent cannula and 

cross-clamp in place. The needle also allows aortic root vent-

ing to be performed. Retrograde cardioplegia catheters can 

also be directly inserted. At our center, we prefer not to use 

retrograde cardioplegia because it is difficult to assess the 

position of the catheter as well as to confirm the adequacy of 

delivery. Furthermore, a coronary sinus injury would be a 

significant complication in the minimally invasive setting. 

Antegrade delivery of cardioplegia can be either intermittent 

with traditional blood or crystalloid cardioplegia or a 1-dose 

delivery using either 2 L of Bretschneider (Custodiol)

41

 or 

1.2 L of del Nido cardioplegia solutions.

In summary, we recommend the following strategies for 

cardioplegia delivery during minimally invasive procedures:

•

• antegrade delivery through direct aortic root can-

nulation, and

•

• single-dose cardioplegia (Custodiol or del Nido) may 

safely facilitate uninterrupted surgical progress.

Conclusion

Minimally invasive cardiac surgery is performed com-

monly with outcomes comparable to the conventional ster-

notomy approach. With a thorough understanding of the 

foundational concepts of these procedures, they can be per-

formed safely and effectively. Each individual patient 

requires surgical, anesthetic, and perfusion collaboration to 

identify the optimal strategy for that patient’s operation.

Acknowledgment

Some portions of this review were presented in a syllabus for an 

invited lecture at the Society of Cardiovascular Anesthesiologist’s 

14th Annual Update on Cardiopulmonary Bypass Conference.