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 ,Revised 16 January 2009 ,Accepted 20 February 2009.

References 

  1. Thomas TV. Vents in open heart procedures: techniques and selection. J Cardiovasc Surg (Torino). 1971;12:366–370
  2. Dalmas JP, Eker A, Girard C, Flamens C, Neidecker J, Obadia JF, et al. Intracardiac air clearing in valvular surgery guided by transesophageal echocardiography. J Heart Valve Dis. 1996;5:553–557
  3. Diehl JT, Ramos D, Dougherty F, Pandian NG, Payne DD, Cleveland RJ. Intraoperative, two-dimensional echocardiography-guided removal of retained intracardiac air. Ann Thorac Surg. 1987;43:674–675
  4. Duff HJ, Buda AJ, Kramer R, Strauss HD, David TE, Berman ND. Detection of entrapped intracardiac air with intraoperative echocardiography. Am J Cardiol. 1980;46:255–260
  5. Orihashi K, Matsuura Y, Hamanaka Y, Sueda T, Shikata H, Hayashi S, et al. Retained intracardiac air in open heart operations examined by transesophageal echocardiography. Ann Thorac Surg. 1993;55:1467–1471
  6. Oka Y, Inoue T, Hong Y, Sisto DA, Strom JA, Frater RWM. Retained intracardiac air - transesophageal echocardiography for definition of incidence and monitoring removal by improved techniques. J Thorac Cardiovasc Surg. 1986;91:329–338
  7. Tingleff J, Joyce FS, Pettersson G. Intraoperative echocardiographic study of air embolism during cardiac operations. Ann Thorac Surg. 1995;60:673–677
  8. Abu-Omar Y, Cifelli A, Matthews PM, Taggart DP. The role of microembolisation in cerebral injury as defined by functional magnetic resonance imaging. Eur J Cardiothorac Surg. 2004;26:586–591
  9. Bokeriia LA, Golukhova EZ, Breskina NY, Polunina AG, Davydov DM, Begachev AV, et al. Asymmetric cerebral embolic load and postoperative cognitive dysfunction in cardiac surgery. Cerebrovasc Dis. 2007;23:50–56
  10. Orihashi K, Matsuura Y, Sueda T, Shikata H, Mitsui N, Sueshiro M. Pooled air in open heart operations examined by transesophageal echocardiography. Ann Thorac Surg. 1996;61:1377–1380
  11. Koul BL, Al-Rashidi F, Roijer A, Meurling C. A new technique to reduce residual air emboli in open left cardiac surgery. J Thorac Cardiovasc Surg. Epub 9 March 2009.
  12. Brucher R, Russell D. Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler. Stroke. 2002;33:1969–1974
  13. Shah DA, Madden LV. Nonparametric analysis of ordinal data in designed factorial experiments. Phytopathology. 2004;94:33–43
  14. Fishman NH, Carlsson E, Roe BB. The importance of the pulmonary veins in systemic air embolism following open-heart surgery. Surgery. 1969;66:655–662
  15. Rodriguez RA, Cornel G, Weerasena NA, Splinter WM. Effect of Trendelenburg head position during cardiac deairing on cerebral microemboli in children: a randomized controlled trial. J Thorac Cardiovasc Surg. 2001;121:3–9
  16. Bagdonas AA, Stuckey JH, Dennis C, Piera J. Studies of the effects of position on the development of cerebral air embolism during open-heart surgery. Surgery. 1962;52:487–493
  17. Borger MA, Peniston CM, Weisel RD, Vasiliou M, Green REA, Feindel CM. Neuropsychological impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. J Thorac Cardiovasc Surg. 2001;121:743–749
  18. Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke. 1994;25:1393–1399
  19. Stump D, Rogers A, Hammon J, Newman S. Cerebral emboli and cognitive outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 1996;10:113–119
  20. Braekken SK, Reinvang I, Russell D, Brucher R, Svennevig JL. Association between intraoperative cerebral microembolic signals and post-operative neuropsychological deficits: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J Neurol Neurosurg Psychiatry. 1998;65:573–576
  21. Svenarud P, Persson M, van der Linden J. Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation. 2004;109:1127–1132
  22. MacRae WR, Masson AHB, Owen JA, Campbell DG. Carbon dioxide acidosis during open heart surgery. Br J Anaesth. 1964;36:793–797

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