Morbidity and mortality associated with large-bore percutaneous venovenousbypass cannulation for 312 orthotopic liver transplantations

The aim of this study is to establish the incidence of serious morbidity an d mortality associated with the placement of large-bore (1.8 to 20 F) percu taneous bypass cannulae for venovenous bypass (VVBP) during orthotopic live r transplantation (OLT), This technique has been reported to be rapid, simp le, and safe. We reviewed the case notes of 312 patients who underwent OLT in our center using this technique. We describe 4 cases of serious morbidit y (incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to per cutaneous placement of the bypass cannula, We conclude that percutaneous ca nnula placement for VVBP during OLT has the potential for life-threatening complications, and this must be considered when electing to use this techni que. When percutaneous cannulae are to be used, we recommend the use of the right internal jugular vein for return cannulation and the use of ultrasou nd guidance, particularly in those patients in whom cannulation is predicta bly difficult.