Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: A randomized clinical trial

Al-Rashidi, Faleh; Landenhed, Maya; Blomquist, Sten; Höglund, Peter; Karlsson, Per-Axel; Pierre, Leif; Koul, Bansi

doi:10.1016/j.jtcvs.2010.07.013

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 5 , Pages 1128-1133, May 2011

Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: A randomized clinical trial

Faleh Al-Rashidi, MD
- Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden
Maya Landenhed, MD
- Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden
Sten Blomquist, MD, PhD
- Department of Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital in Lund, University of Lund, Sweden
Peter Höglund, MD, PhD
- Clinical Research and Competence Center, Skane University Hospital in Lund, University of Lund, Sweden
Per-Axel Karlsson, EBCP
- Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden
Leif Pierre, CCP, BSc
- Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden
Bansi Koul, MD, PhD
- Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden
- Address for reprints: Bansi Koul, MD, PhD, Cardiothoracic Surgery, A Block, Floor 8, Skane University Hospital in Lund, 221 85 Lund, Sweden.

Received 1 April 2010; received in revised form 7 June 2010; accepted 3 July 2010. published online 03 September 2010.

Objective

We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique.

Methods

Twenty patients undergoing elective open aortic valve surgery were randomized prospectively to the Lund technique (Lund group, n = 10) or the carbon dioxide insufflation technique (carbon dioxide group, n = 10). Both groups were monitored intraoperatively during de-airing and for 10 minutes after weaning from cardiopulmonary bypass by transesophageal echocardiography and online transcranial Doppler for the severity and the number of gas emboli, respectively. The systemic arterial partial pressure of carbon dioxide and pH were also monitored in both groups before, during, and after cardiopulmonary bypass.

Results

The severity of gas emboli observed on transesophageal echocardiography and the number of microembolic signals recorded by transcranial Doppler were significantly lower in the Lund group during the de-airing procedure (P = .00634) and in the first 10 minutes after weaning from cardiopulmonary bypass (P = .000377). Furthermore, the de-airing time was significantly shorter in the Lund group (9 vs 15 minutes, P = .001). The arterial pH during the cooling phase of cardiopulmonary bypass was significantly lower in the carbon dioxide group (P = .00351), corresponding to significantly higher arterial partial pressure of carbon dioxide (P = .005196) despite significantly higher gas flows (P = .0398) in the oxygenator throughout the entire period of cardiopulmonary bypass.

Conclusions

The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred.

CTSNet classification: 19, 25, 31, 35

Abbreviations and Acronyms: CO₂, carbon dioxide, CPB, cardiopulmonary bypass, LV, left ventricle, MES, microembolic signals, pCO₂, partial pressure of CO₂, TCD, transcranial Doppler, TEE, transesophageal echocardiography