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J Thorac Cardiovasc Surg 2003;126:2011-2015
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery

^a Department of Anesthesia, Far Eastern Memorial Hospital, Taipei, Taiwan
^b Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
^c Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Received for publication June 12, 2003; revisions received July 6, 2003; accepted for publication July 21, 2003.

^* Address for reprints: Dr Ming-Jiuh Wang, Associate Professor, Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan South Road, Taipei, Taiwan 100
canon{at}ha.mc.ntu.edu.tw

OBJECTIVES: Our objectives were to determine the incidence and severity and the time course of the CO₂ embolism during endoscopic saphenous vein harvesting with CO₂ insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring.

METHODS: Four hundred three consecutive patients scheduled for off-pump coronary artery bypass grafting surgery or femoral-to-popliteal artery bypass grafting surgery were prospectively studied. Multiplane transesophageal echocardiography with a new transgastric view was used to monitor CO₂ bubbles in the inferior vena cava and hepatic vein.

RESULTS: CO₂ embolisms occurred in 17.1% of patients. Minimal, moderate, and massive CO₂ embolisms occurred in 13.1%, 3.5%, and 0.5%, respectively. The occurrence of moderate and massive CO₂ embolisms was frequently associated with the surgical manipulation of branches of saphenous veins. No significant risk factors were identified in multiple logistic regression analysis.

CONCLUSION: The incidence of significant CO₂ embolism during endoscopic saphenous vein harvesting with CO₂ insufflation procedures was more than 4%. Continuous transesophageal echocardiographic monitoring of the CO₂ bubbles in the inferior vena cava is essential in early detection and can help to prevent the development of significant CO₂ embolisms in these patients.

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