Particulate emboli capture by an intra-aortic filter device during cardiac surgery

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica Particulate emboli capture by an intra-aortic filter device during aortic valve replacement Abstract Objective: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA).Methods: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed.Results: There were no strokes or gross neurological events. There were no cases of postoperative renal failure." No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in two it was not possible to determine the nature of the particulates captured. Conclusion:The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis. Descriptors INTRODUCTIONStrokes are the third leading cause of death in developed countries and the main cause of physical disability [1]. Over the last few years, neurological lesions during heart surgery have received special attention from surgeons. About 3.8% of patients submitted to coronary artery bypass grafting and up to 10% of those who undergo aortic valve replacement suffer strokes [3,4].Neurological events are associated to substantial increases in mortality, hospitalization and costs over the medium and long terms. Much effort has been spent to minimize the risks of these complications. Although the causes of neurological complications are multifactorial, age and atherosclerosis have been identified as the main risk factors [5,6].Studies have evaluated the capacity and safety of intraaortic filters to capture fragments released in the intraoperative period of patients undergoing CABG. The results not only demonstrated the safety of the device but also its capacity to capture fragments in the intra-operative period and the histological composition of the fragments (predominantly of atheromatous origin), as well as identifying that aortic de-clamping was the moment of greatest risk [5].However specific studies to evaluate the use of this device in patients...

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“…The EMBOL-X® System proved to be safe, as no intraoperative complications occurred related to its use, corroborating published data [8,11].…”

Section: Discussionsupporting

confidence: 85%

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica

Filho¹,

Brandão²,

Pomerantzeff³

et al. 2008

Rev Bras Cir Cardiovasc

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“…Because it is believed that dislodgement of aortic atheromatous material during crossclamping may lead to development of embolic ischemic events in the brain and elsewhere, filtration devices have been developed in an attempt to capture potentially embolic material (179). The ability of these devices to prevent renal injury during or after cardiac surgery has not been documented; however, it is worth noting that no technology (e.g., intraaortic filter and dynamic bubble trap) has been shown to reduce the incidence of neurologic injury, which may occur through this mechanism (180).…”

Section: Prevention Of Aki Nonpharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

259

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…1,2 Previous observations indicate that solid emboli are more likely released at certain surgical maneuvers during CPB. 2,3,5 We sought to study the time course and distribution of HITS occurring at different surgical periods during CPB for CABG surgery and their association with POCD. Our findings in a large number of patients indicate that there is no correlation between the counts of HITS during either the entire CPB or at any of the surgical periods during CPB and the incidence of POCD after CABG surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This hypothesis has been supported by findings of microscopic clots in the aortic cannula after decannulation in patients undergoing CPB 3 and the presence of fat emboli, as evidenced by small arteriolar dilatations, in the brains of patients who died after CPB. 4 Transcranial Doppler (TCD) has become 1 of the principal tools to document cerebral emboli during surgery in clinical studies assessing strategies to improve neurological outcome after CPB.…”

mentioning

confidence: 83%

“…[2][3][4] Solid emboli in particular are more likely associated with adverse neurological events such as stroke 7 and perhaps cognitive deficits. 2,4,8 Some studies 2,3,5,6 have suggested that during CPB, solid emboli are more frequently released during certain surgical maneuvers. If solid emboli represented by HITS are in fact associated with POCD, then this association would be best detected during such maneuvers.…”

mentioning

confidence: 99%

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Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

Rodriguez

Rubens

Wozny

et al. 2010

Stroke

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Background and Purpose-High-intensity transient signals (HITS) are the transcranial Doppler representation of both air and solid cerebral emboli. We studied the frequency of HITS associated with different surgical maneuvers during cardiopulmonary bypass for coronary artery bypass graft surgery and their association with postoperative cognitive dysfunction (POCD). Methods-We combined 356 patients undergoing coronary artery bypass graft from 2 clinical trials who had both neuropsychological testing (before, 1 week and 3 months after surgery) and transcranial Doppler during cardiopulmonary bypass. HITS were grouped into periods that included: cannulation, cardiopulmonary bypass onset, aortic crossclamp-on, aortic crossclamp-off, side clamp-on, side clamp-off, and decannulation. POCD was defined by a decreased combined Z-score of at least 2.0 or reduction in Z-scores of at least 2.0 in 20% of the individual tests. Results-Incidence of POCD was 47.3% and 6.3% at 1 week and 3 months after surgery. There was no association between cardiopulmonary bypass counts of HITS and POCD at 1 week (Pϭ0.617) and 3 months (Pϭ0.110). No differences in HITS counts were identified at any of the surgical periods between patients with and without POCD. Factors affecting HITS counts were surgical period (PϽ0.0001), blood flow velocity (Pϭ0.012), cardiopulmonary bypass duration (Pϭ0.040), and clinical study (Pϭ0.048). Conclusions-Although cerebral microemboli have been implicated in the pathogenesis of POCD, in this study that included low-risk patients undergoing coronary artery bypass surgery, there was no demonstrable correlation between the counts of HITS and POCD. (Stroke. 2010;41:2229-2235.)

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Particulate emboli capture by an intra-aortic filter device during cardiac surgery

Abstract: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.

Cited by 65 publications

References 15 publications

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica

AKI Associated with Cardiac Surgery

Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

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