Air Removal Efficiency of a Venous Bubble Trap in a Minimal Extracorporeal Circuit During Coronary Artery Bypass Grafting

Roosenhoff, Tamara P.A.; Stehouwer, Marco C.; Vroege, Roel de; Butter, René P.; Boven, Wim-Jan van; Bruins, Peter

doi:10.1111/j.1525-1594.2009.00986.x

Cited by 30 publications

(17 citation statements)

References 26 publications

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“…Thus, the VBT strongly increases the safety of this closed-loop circuit concerning air handling. A MECC system with a VBT signi fi cantly reduces the volume of GME and strongly reduces the quantity of large emboli (>500 m m) [ 62 ] . A VBT can be interconnected in the venous line before the centrifugal pump.…”

Section: Venous Bubble Trapmentioning

confidence: 99%

MECC Equipment

Anastasiadis¹,

Antonitsis²,

Argiriadou³

2012

Principles of Miniaturized ExtraCorporeal Circulation

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Section: Venous Bubble Trapmentioning

confidence: 99%

MECC Equipment

Anastasiadis¹,

Antonitsis²,

Argiriadou³

2012

Principles of Miniaturized ExtraCorporeal Circulation

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“…This detailed information that can be obtained by the new‐generation bubble detectors was shown in Fig. 4 (1). We did not refer to these data in our conclusions.…”

mentioning

confidence: 96%

“…We appreciate the interest expressed by Simons and Weerwind regarding our article/study on air removal characteristics of a venous bubble trap (VBT) during cardiopulmonary bypass (1).…”

mentioning

confidence: 99%

Air Removal Efficiency of a Venous Bubble Trap in a Minimal Extracorporeal Circuit During Coronary Artery Bypass

Stehouwer¹

2011

Artificial Organs

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We appreciate the interest expressed by Simons and Weerwind regarding our article/study on air removal characteristics of a venous bubble trap (VBT) during cardiopulmonary bypass (1).The authors' remark on the unknown bubble load of the centrifugal pump is absolutely correct. Besides the bubble load, the extent of bubble fractionation by the centrifugal pump is unknown. We did not measure directly behind the VBT because of the limitations of the bubble counter. The bubble counter as used in our study can only accurately measure microbubbles between 20 and 500 mm. We hypothesized that the centrifugal pump would fractionate bigger bubbles to smaller microbubbles by which we could measure the reduction of microbubble volume more precisely. This detailed information that can be obtained by the new-generation bubble detectors was shown in Fig. 4 (1). We did not refer to these data in our conclusions.Because we were interested in the air removal characteristic of the VBT separately, we chose not to measure microbubbles in the arterial line, as the interpretation of such could have introduced new difficulties through the influence of the oxygenator.Although the source of microbubbles was not the scope of our study, we support the thoughts of Simons and Weerwind regarding the use of kinetic-assisted venous drainage. The use of this drainage technique in our minimized circuit may indeed contribute to the formation of microbubbles. To minimize this known effect of microbubble generation, a safety stop for reducing the maximum negative pressure for venous drainage is present, that is, when the venous line pressure drops below -40 mm Hg, the arterial pump will slow down and flow is reduced. Despite this pressure management, we occasionally observed venous line pressure peaking down to a minimum of approximately -120 mm Hg during a few seconds maximum.The process of cavitation will occur when the negative pressure is below the vapor pressure of water (approximately -45 mm Hg) and will be reversed as soon as the pressure is higher than this vapor pressure (2). However, the possible bubble-stabilizing properties of blood may play a role (3). Because we almost never reached these negative pressures, we are convinced that cavitation was rarely present and mostly did not influence our results. However, the remark of Simons and Weerwind about cavitation and negative pressure is correct, and the venous line pressure is important in future gaseous emboli research.In our opinion, there are two other sources of gaseous emboli in the venous line. First, air can enter the system through the venous cannulation site (despite double snaring), and second, air could be introduced into the right atrium by infusion of medications mixed with small amounts of air, both before and during the procedure.The announced research on the correlation between bubble formation and negative pressure could clarify another source of gaseous microemboli. Therefore, we are very much interested in the results of future studies focused on the contribution of negat...

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“…In the December 2010 issue of your journal, we read the interesting article by Roosenhoff et al., in which they demonstrated that a venous bubble trap reduces arterial gaseous emboli during minimized cardiopulmonary bypass (1). Entrapped bubbles are prevented from entering the centrifugal pump, and finally, the patient.…”

mentioning

confidence: 99%