Pulsatile flow decreases gaseous micro-bubble filtering properties of oxygenators without integrated arterial filters during cardiopulmonary bypass

Milano, Aldo Domenico; Dodonov, Mikhail; Menon, Tiziano; Gottin, Leonardo; Malerba, Giovanni; Mazzucco, Alessandro; Faggian, Giuseppe

doi:10.1093/icvts/ivt264

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…For monitoring of these, the bubble counter system in this study has been found to reliably identify gaseous microbubbles in an extracorporeal circulation loop in basic and clinical investigations. 10,18 Given the strong correlation between LA microbubbles observed on ICE during radiofrequency ablation and sheath/catheter flushes to peripherally detected microbubble volumes, this study suggests that sheath/catheter procedural steps are a source of microbubbles independent of radiofrequency application. …”

Section: Characterization Of Microbubbles In Catheter Interventionsmentioning

confidence: 74%

Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model

Takami

Lehmann

Parker

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Formation of microemboli during catheter ablation has been suggested as a cause for asymptomatic cerebral emboli. However, it is unknown which part of the process and ablation setting/strategy is most strongly related to this occurrence. Methods and Results-A total of 27 pigs were used. Catheter/sheath manipulations in left atrium were performed in 25 of 27 pigs outfitted with microemboli monitoring systems. Ablations using open-irrigated radiofrequency catheters were performed in 18 of 25 pigs. Two of 27 pigs did not undergo left atrial procedures and were injected with microembolic materials in the carotid artery to serve as positive controls. In total, 334 sheath/catheter manipulations (transseptal puncture, sheath flushing, catheter insertion, pulmonary vein venography, and sheath exchange) and 333 radiofrequency applications (power setting, 30/50 W; point-by-point/drag ablations) were analyzed. High microbubble volume in the extracorporeal circulation loop and a high number of microembolic signals in carotid artery were observed during sheath/ catheter manipulations especially in saline/contrast injections at fast speed and ablations with steam pop. Fast sheath flushing produced significantly higher microbubble volume than slow sheath flushing (median, 12 200 versus 121 nL; P<0.0001). A total of 44 of 126 (35%) blood filters in the circulation loop showed microparticles (thrombus/coagulum and tissue). Most of them were seen after radiofrequency application especially in 50-W ablations, drag ablations, and steam pop. Brain magnetic resonance imaging showed positive-embolic lesions in control pigs. Conclusions-Formation of microbubbles was the greatest during fast saline/contrast injections and steam pops, whereas high-power radiofrequency applications, drag ablations, and steam pops produced most of the microparticles.(Circ Arrhythm Electrophysiol. 2016;9:e003226.

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Section: Characterization Of Microbubbles In Catheter Interventionsmentioning

confidence: 74%

Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model

Takami

Lehmann

Parker

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Two other studies have reported a clinical comparison of integrated and non-integrated devices. A randomised controlled trial by Milano et al 12 investigated emboli filtration during either pulsatile or non-pulsatile flow in patients undergoing myocardial revascularisation, using three different oxygenator filter combinations (integrated filtration Terumo Capiox FX25, Sorin Synthesis and the non-integrated Maquet Quadrox-i-Adult membrane oxygenator + 40 µm ALF). They concluded that, in these earlier generation devices, compared to those in the present study, pulsatile perfusion decreased emboli filtration with a significant difference seen in the non-integrated oxygenator.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of emboli removal by integrated versus non-integrated arterial filters in new generation oxygenators

et al. 2015

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The new generation Sorin Inspire 6 M, with a stand-alone 20 µm arterial filter, appeared most efficient at removing incoming emboli from the circuit. No firm conclusions can be drawn about the relative efficacy of emboli removal by units categorised by class (integrated vs non-integrated); however, the stand-alone 20 µm arterial filter presently sets a contemporary standard against which other configurations of equipment can be judged.

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“…When the purge line was kept open, more GME appeared at the preoxygenator site in the Quadrox group. A clinical study by Milano and colleagues also showed that more GME were detected at the preoxygenator site when using the Quadrox‐i adult oxygenator than Capiox FX25 oxygenator . Therefore, the separated venous and cardiotomy filters may be a good choice to reduce the effect of the suction blood in the cardiotomy reservoir.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Capiox RX25 and Quadrox-i Adult Hollow Fiber Membrane Oxygenators in a Simulated Cardiopulmonary Bypass Circuit

2015

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The Capiox RX25 and Quadrox-i Adult oxygenators are commonly used in clinical adult cardiopulmonary bypass circuits. This study was designed to test the effectiveness of two adult oxygenators in order to evaluate gaseous microemboli (GME) trapping capability and hemodynamic performance. A simulated adult CPB circuit was used and primed with Ringer's lactate and packed red blood cells (hematocrit 25%). All trials were conducted at flow rates of 2-5 L/min (1 L/min increments) with a closed and open arterial filter purge line at 35°C. The postcannula pressure was maintained at 100 mm Hg. After a 5 cc of bolus air was introduced into the venous line, an Emboli Detection and Classification system was used to detect and classify GME at the preoxygenator, postoxygenator, and precannula sites. At the same time, real-time pressure and flow data were recorded, and hemodynamic energy was calculated using a custom-made data acquisition system and Labview software. Our results showed that the oxygenator pressure drops of Quadrox-i Adult oxygenator were lower than Capiox RX25 at all flow rates. The Quadrox-i Adult oxygenator retained more hemodynamic energy across the oxygenator. Both oxygenators could trap the majority of GME, but Capiox RX25 did better than the Quadrox-i Adult oxygenator. No GME was delivered to the pseudo patient at all flow rates in the Capiox group. The Capiox RX25 venous reservoir could capture more GME at lower flow rates, while the Quadrox-i Adult venous reservoir performed better at higher flow rates. An open arterial filter purge line reduced GME slightly in the Capiox group, but GME increased in the Quadrox group. The Quadrox-i Adult oxygenator is a low-resistance, high-compliance oxygenator. The GME handling ability of Capiox RX25 performed well under our clinical setting. Further optimized design for the venous/cardiotomy reservoir is needed.

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Pulsatile flow decreases gaseous micro-bubble filtering properties of oxygenators without integrated arterial filters during cardiopulmonary bypass

Abstract: Pulsatile flow decreases gaseous micro-bubble filtering properties of oxygenators without integrated arterial filters during CPB. PP requires specially designed circuit components to avoid the risk of additional GMB delivery.

Cited by 17 publications

References 22 publications

Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model

Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model

Clinical evaluation of emboli removal by integrated versus non-integrated arterial filters in new generation oxygenators

Evaluation of Capiox RX25 and Quadrox-i Adult Hollow Fiber Membrane Oxygenators in a Simulated Cardiopulmonary Bypass Circuit

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