Intracardiac Air Clearing in Valvular Surgery Guided by Transesophageal Echocardiography

Dalmas, J. P.; Flamens, C.; Girard, C.; Mikaeloff, P; Estanove, S

doi:10.1097/00000542-199409001-00111

Cited by 12 publications

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“…[1][2][3] The notoriously ineffective manual de-airing techniques have proved unable to eliminate the microemboli. 4 Even if the techniques are meticulously adhered to, large numbers of microemboli still occur. 4 -6 Other possibilities should therefore be explored.…”

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confidence: 99%

Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

2004

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Background-The risks that the presence of air microemboli implies in open-heart surgery have recently been emphasized by reports that their number is correlated with the degree of postoperative neuropsychological disorder. Therefore, we studied the effect of CO 2 insufflation into the cardiothoracic wound on the incidence and behavior of microemboli in the heart and ascending aorta. Methods and Results-Twenty patients undergoing single-valve surgery were randomly divided into 2 groups. Ten patients were insufflated with CO 2 via a gas diffuser, and 10 were not. Microemboli were ascertained by intraoperative transesophageal echocardiography (TEE) and recorded on videotape from the moment that the aortic cross-clamp was released until 20 minutes after end of cardiopulmonary bypass (CPB). The surgeon performed standard de-airing maneuvers without being aware of TEE findings. Postoperatively, a blinded assessor determined the maximal number of gas emboli during each consecutive minute in the left atrium, left ventricle, and ascending aorta. The 2 groups did not differ in the usual clinical parameters. The median number of microemboli registered during the whole study period was 161 in the CO 2 group versus 723 in the control group (PϽ0.001). Corresponding numbers for the left atrium were 69 versus 340 (PϽ0.001), left ventricle 68 versus 254 (PϽ0.001), and ascending aorta 56 versus 185 (PϽ0.001). In the CO 2 group, the median number of detectable microemboli after CPB fell to zero 7 minutes after CPB versus 19 minutes in the control group (PϽ0.001). Conclusions-Insufflation of CO 2 into the thoracic wound markedly decreases the incidence of microemboli. (Circulation.

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Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

2004

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“…Indeed, Dalmas et al 6 concluded that even if TEE guided surgical de-airing was used in valve surgery, it was impossible to "clear intracardiac air".…”

Section: Can the Results Be Generalized Or Does The Study Design Put mentioning

confidence: 99%

“…After CPB, however, they 8 observed such bubbles in only 12 of their 15 patients (80%) while the figures reported by others are even lower. Rodrigas et al 29 observed left ventricular bubbles in 39 of 58 patients (67%) and Dalmas et al 6 using a three or four chamber TEE view did so in 25 out of 42 patients (59%).…”

Section: Incidence Of Microbubbles In Valve Surgerymentioning

confidence: 97%

“…Earlier studies have used arbitrary scales to grade the amount of intracardiac microemboli. 6,8,29 The use of such scales may be convenient but loss of information is unavoidable. We have therefore tried to determine the amount of air in the left atrium, left ventricle and proximal part of the ascending aorta in a different manner.…”

Section: Assessment Of Microbubblesmentioning

confidence: 99%

“…Unfortunately, these manual de-airing techniques have proved unable to eliminate retained air. 6 It has been found that, even if these techniques are meticulously adhered to, large numbers of microemboli still occur. [6][7][8] Consequently, other methods should be explored to rid the heart and the arteries of air bubbles.…”

Section: Introductionmentioning

confidence: 99%

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Carbon dioxide de‐airing in cardiac surgery

Svenarud¹

2006

Acta Anaesthesiol Scand

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(ENG)Background: The risks connected with the presence of air microemboli in open-heart surgery, have recently been emphasized by reports that their number is correlated with the degree of postoperative neuropsychological disorder. Insufflation of carbon dioxide (CO 2 ) into the chest wound is used in open-heart surgery to de-air the heart and great vessels. A new insufflation device, a gas-diffuser, was compared with traditional devices for de-airing in an experimental wound model. Finally, to assess the clinical value of CO 2 insufflation into the cardiothoracic wound, the effect of such insufflation on the incidence and behavior of microemboli in the heart and ascending aorta was studied under the conditions of a randomized clinical trial. Methods: In a cardiothoracic wound model, a full-size torso, the degree of air displacement achieved by the gas-diffuser, was compared with that of a 2.5 mm open-ended tube, a 6.35 mm open-ended tube, a multi-perforated catheter, and a gauze sponge, respectively, during steady state. The influence of suction, varying CO 2 flow rates, an open pleural cavity, exposure to fluids and the position of the device were also evaluated. De-airing was assessed by measuring the remaining air content at the right atrium. In the trial, twenty (20) patients undergoing single valve surgery were randomly divided into two groups. Ten patients were insufflated with CO 2 via a gas-diffuser and ten were not. Microemboli were ascertained by intraoperative transesophageal echocardiography (TEE) from release of the aortic cross-clamp until 20 minutes after end of cardiopulmonary bypass (CPB). Results: During steady state, the gas-diffuser produced efficient air displacement in the wound cavity model at CO 2 flows of ³5 l/min (£0.65% remaining air), while the 2.5mm and 6.35mm open-ended tube were much less efficient with ³82% and >19.5% remaining air, respectively, at 2.5-10 l/min CO 2 flows (p<0.001). When using the gas-diffuser, an open pleural cavity prolonged the time needed to obtain a high degree of air displacement in the wound cavity (p=0.001). With suction of 10 l/min the median air content was still low (£0.50%) at a simultaneous CO 2 flow of 10 l/min. Conversely, suction of 25 l/min caused a marked increase in air content both at a CO 2 flow of 5 and 10 l/min (p<0.001). When exposed to fluid, the gauze sponge and the multi-perforated catheter immediately became inefficient (70% and 96% air, respectively), whereas the gas-diffuser remained efficient (0.4% air). The two patient groups did not differ in clinical parameters. The median number of microemboli registered during the whole study period was 161 in the CO 2 group versus 723 in the control-group (p<0.001). Corresponding numbers for the left atrium were 69 versus 340 (p<0.001), left ventricle 68 versus 254 (p<0.001), ascending aorta 56 versus 185 (p<0.001). In the CO 2 group the median number of detectable microemboli after CPB fell to zero 7 minutes after CPB versus 19 minutes in the control group (p<0.001). Conclusion:The ...

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Intracardiac Air Clearing in Valvular Surgery Guided by Transesophageal Echocardiography

Cited by 12 publications

References 0 publications

Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

Carbon dioxide de‐airing in cardiac surgery

Three‐dimensional echocardiography to confirm persistent intracardiac air bubbles after mitral valve surgery

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Intracardiac Air Clearing in Valvular Surgery Guided by Transesophageal Echocardiography

Cited by 12 publications

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Effect of CO 2 Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

Effect of CO 2 Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

Carbon dioxide de‐airing in cardiac surgery

Three‐dimensional echocardiography to confirm persistent intracardiac air bubbles after mitral valve surgery

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Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery

Effect of CO ₂ Insufflation on the Number and Behavior of Air Microemboli in Open-Heart Surgery