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Eur J Cardiothorac Surg 2001;20:614-620
© 2001 Elsevier Science NL

Optimization of venous return tubing diameter for cardiopulmonary bypass

^a Department of Cardiothoracic Surgery, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, China
^b Department for Cardiovascular Surgery, University Hospital, Zurich, Switzerland
^c Department for Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland

Received 21 February 2001; received in revised form 14 May 2001; accepted 31 May 2001.

Corresponding author. Tel.: +41-21-314-2280; fax: +41-21-314-2278
e-mail: ludwig.von-segesser{at}chuv.hospvd.ch

Objective: To determine the optimal venous tubing diameter for adult cardiopulmonary bypass (CPB) to improve gravity drainage and to reduce priming volume. Methods: (A) Maximum bovine blood flow rates by gravity drainage were assessed in vitro for four different tubing diameters (1/2, 3/8, 5/16,1/4 inch) with three different lengths and various pre- and afterloads. Based on the results of (A) and multiple regression analyses, we developed equations to predict tubing sizes as a function of target flows. (C) The equations obtained in (B) were validated by ex vivo bovine experiments. (D) The clinically required maximal flows were determined retrospectively by reviewing 119 perfusion records at Zurich University. (E) Based on our model (B), the clinical patient and hardware requirements, the optimal venous tubing diameter was calculated. (F) The optimized venous tubing was evaluated in a prospective clinical trial involving 312 patients in Hangzhou. Results: For a mean body surface area of 1.83±0.2 m², the maximal perfusion flow rate (D) achieved with 1/2-inch (=1.27 cm²) venous tubing was 4.62±0.57 l/min (range: 2.50–6.24 l/min). Our validated model (B,C) predicted 1.0 cm² as optimal cross-sectional area for the venous line. New tubing packs developed accordingly were used routinely thereafter. The maximal flow rate was 4.93±0.58 l/min (range: 3.9–7.0) in patients with a mean body surface area of 1.62±0.21 m². Conclusion: The new venous tubing with 1.0-cm² cross-sectional area improves the drainage in the vast majority of adult patients undergoing CPB and reduces the priming volume (-27 ml/m). Reduced hemodilution can prevent homologous transfusions if a predefined transfusion trigger level is not reached.

Key Words: Cardiopulmonary bypass • Gravity drainage • Venous line • Priming volume • Extracorporeal circulation

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