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J Thorac Cardiovasc Surg 2003;126:1455-1460
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

The dynamic air bubble trap reduces cerebral microembolism during cardiopulmonary bypass

^a Department of Thoracic and Cardiovascular Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
^b Department of Anesthesiology and Intensive Care Medicine, Kerckhoff-Klinik, Bad Nauheim, Germany
^c Department of Hemostaseology and Transfusion Medicine, Kerckhoff-Klinik, Bad Nauheim, Germany
^d Department of Cardiovascular Surgery, University of Giessen, Giessen, Germany
^e Department of Statistics, Iowa State University, Ames, Iowa, USA

Received for publication August 8, 2002; revisions received October 10, 2002; revisions received October 24, 2002; accepted for publication March 13, 2003.

^* Address for reprints: Markus Schoenburg, MD, Department of Thoracic and Cardiovascular Surgery, Kerckhoff-Clinic Foundation, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
markus.schoenburg{at}kerckhoff.med.uni-giessen.de

OBJECTIVE: Neuropsychologic disorders are common after coronary artery bypass operations. Air microbubbles are identified as a contributing factor. A dynamic bubble trap might reduce the number of gaseous microemboli.

METHODS: A total of 50 patients undergoing coronary artery bypass operation were recruited for this study. In 26 patients a dynamic bubble trap was placed between the arterial filter and the aortic cannula (group 1), and in 24 patients a placebo dynamic bubble trap was used (group 2). The number of high-intensity transient signals within the proximal middle cerebral artery was continuously measured on both sides during bypass, which was separated into 4 periods: phase 1, start of bypass until aortic clamping; phase 2, aortic clamping until rewarming; phase 3, rewarming until clamp removal; and phase 4, clamp removal until end of bypass. S100ß values were measured before, immediately after, and 6 and 48 hours after the operation and before hospital discharge.

RESULTS: The bubble elimination rate during bypass was 77% in group 1 and 28% in group 2 (P < .0001). The number of high-intensity signals was lower in group 1 during phase 1 (5.8 ± 7.3 vs 16 ± 15.4, P < .05 vs group 2) and phase 2 (6.9 ± 7.3 vs 24.2 ± 27.3, P < .05 vs group 2) but not during phases 3 and 4. Serum S100ß values were equally increased in both groups immediately after the operation. Group 2 patients had higher S100ß values 6 hours after the operation and significantly higher S100ß values 48 hours after the operation (0.06 ± 0.14 vs 0.18 ± 0.24, P = .0133 vs group 2). Age and S100ß values were correlated in group 2 but not in group 1.

CONCLUSION: Gaseous microemboli can be removed with a dynamic bubble trap. Subclinical cerebral injury detectable by increases of S100ß disappears earlier after surgical intervention.

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