The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 157-162, July 2009

A new de-airing technique that reduces systemic microemboli during open surgery: A prospective controlled study

  • Faleh Al-Rashidi, MD

      Affiliations

    • Department of Cardiothoracic Surgery, University Hospital Lund, Sweden
    • ,
  • Sten Blomquist, MD, PhD

      Affiliations

    • Department of Cardiothoracic Anesthesiology, University Hospital Lund, Sweden
    • ,
  • Peter Höglund, MD, PhD

      Affiliations

    • Department of Clinical Research and Competence Center, University Hospital Lund, Sweden
    • ,
  • Carl Meurling, MD, PhD

      Affiliations

    • Department of Cardiology, University Hospital Lund, Sweden
    • ,
  • Anders Roijer, MD, PhD

      Affiliations

    • Department of Cardiology, University Hospital Lund, Sweden
    • ,
  • Bansi Koul, MD, PhD

      Affiliations

    • Department of Cardiothoracic Surgery, University Hospital Lund, Sweden
    • Corresponding Author InformationAddress for reprints: Bansi Koul, MD, PhD, Department of Cardiothoracic Surgery, University Hospital Lund, 221 85 Lund, Sweden.

Received 24 November 2008; received in revised form 16 January 2009; accepted 20 February 2009.

Objective

We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits.

Methods

Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion, and ventilation of lungs during de-airing [study group]). Transesophageal echocardiography and transcranial Doppler continually monitored the air emboli during the de-airing period and for 10 minutes after termination of the cardiopulmonary bypass.

Results

The amount of air embolism as observed on echocardiography and the number of microembolic signals as recorded by transcranial Doppler were significantly less in the study group during the de-airing time (P < .001) and the first 10 minutes after termination of cardiopulmonary bypass (P < .001). Further, the de-airing time was significantly shorter in the study group (10 vs 17 minutes, P < .001).

Conclusion

The de-airing technique evaluated in this study is simple, reproducible, controlled, safe, and effective. Moreover, it is cost-effective because the de-airing time is short and no extra expenses are involved.

CTSNet classification: 19, 25, 35

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, LV, left ventricle, MES, microembolic signals, TCD, transcranial Doppler, TEE, transesophageal echocardiography

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PII: S0022-5223(09)00365-1

doi:10.1016/j.jtcvs.2009.02.037

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 1 , Pages 157-162, July 2009

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