Retrospective Analysis of Air Handling by Contemporary Oxygenators in the Setting of Cardiac Surgery

Abstract

Purpose: Cardiac surgery with the use of extracorporeal circulation is associated with a significant risk for gaseous microemboli (GME) despite excellent surgical techniques and highest operative standards. GME are associated with postoperative neurocognitive dysfunction and negative clinical outcome. This study determines whether oxygenator design has influence on perioperative outcome after cardiac surgery.Methods: Three different oxygenator models with integrated arterial filter (HiliteAF 7000, Fusion Affinity, and Synthesis) were retrospectively evaluated in 55 patients undergoing elective cardiac surgery with the use of extracorporeal circulation. The two-channel ultrasound bubble counter BCC200 was used to detect GME in real time.Results: All three oxygenators differ in terms of structural specifications and have different rates of number and volume GME reduction. The Fusion Affinity had the lowest arterial GME volume (1.81 µL ± 0.23 µL), which was statistically significant compared to the Synthesis (3.37 µL ± 0.71 µL, p = 0.014). However, the Synthesis had lower absolute numbers at the venous GME count (31771 µL ± 6579 µL) versus the Fusion Affinity (49304 µL ± 8196 µL). However, with regard to clinical outcome after cardiac surgery (duration of invasive and non-invasive mechanical ventilation, incidence of delirium, stroke, acute renal failure, or new myocardial infarction), we found no differences between groups.Conclusion: Despite significant differences in the design specifications, all oxygenators eliminated relevant GME volumes safely.

Post-Operative Delirium and Cognitive Dysfunction in Aged Patients Undergoing Cardiac Surgery: A Randomized Comparison between Two Blood Oxygenators

“…We decided to use the Inspire in the comparison population as it represents the method routinely used in our center. According to the literature data [19,22], the results in terms of bubble removal are comparable to other oxygenators such as Fusion or Quadrox. To our knowledge, there are no studies of this type comparing different filters.…”

“…RemoweLL 2 is designed to reduce neurological injury and inflammatory response in patients undergoing cardiac surgery, thanks to its unique and patented cardiotomy features capable to reduce lipids and leukocytes coming from pericardial suction blood, it has a cardiotomy capacity of 800 mL, and it depletes lipids-leukocytes in two steps: a multilayer cascade filtration, for lipids and leukocytes, and a supernatant separator for lipids only). Data in the literature suggest that RemoweLL 2 technology is effective in the filtration of LME (Lipid Micro Emboli) in the clinical setting and the subsequent attenuation of NSE (neuron-specific enolase) release, a known marker of neurologic injury [19].…”