Sistema a vácuo na circulação extracorpórea: vantagens e
               desvantagens

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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ARTIGO DE REVISÃO • Rev Bras Cir Cardiovasc 29 (2) • Apr-Jun 2014 • https://doi.org/10.5935/1678-9741.20140029 copiar

Sistema a vácuo na circulação extracorpórea: vantagens e desvantagens

Autoria SCIMAGO INSTITUTIONS RANKINGS

Revisão sistemática sobre drenagem assistida a vácuo na circulação extracorpórea, demonstrando seus benefícios, desvantagens, por relatos de casos e evidências sobre seus efeitos na microcirculação. Realizou-se pesquisa sistemática, no período de 1997-2012, nas bases de dados do PubMed-Medline, Lilacs e SciELO. Termos: "circulação extracorpórea", "vácuo", "drenagem", "cirurgia cardíaca" e suas correspondentes traduções, em condições variadas. Dos 70 artigos selecionados, 26 foram incluídos na revisão. Embora a drenagem assistida a vácuo possua potencial significante de complicações e exija tecnologia e profissionalismo respectivo adequado, prevaleceu na literatura revisada o conceito de que a drenagem assistida a vácuo contribuiu na redução no índice de transfusões, hemodiluições, melhor campo operatório, não aumento de hemólise significativa, redução de complicações pós-cirúrgicas, uso de menor prime e uso de cânulas de menor calibre.

Circulação Extracorpórea; Revisão; Cirurgia Torácica

Characteristics	Número de Estudos ^{(referências)}
Redução em transfusões	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.^]
Redução em hemodiluições	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.^]
Melhor campo operatório	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.^]
Hemólise não significante	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.^]
Redução nas complicações pós-cirúrgicas	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.^]
Menor volume de prime	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. ^]
Menor diâmetro de cânulas	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. ^]
Alto risco	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.^]
Limitações	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.^]
Embolia aerífera	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] Endereço para correspondência: Fernando Augusto de Lima Marson, Unicamp - Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, SP, Brasil - CEP: 13083-887. E-mail: fernandolimamarson@hotmail.com