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J Thorac Cardiovasc Surg 2009;138:157-162
© 2009 The American Association for Thoracic Surgery

Evolving Technology/Basic Science

A new de-airing technique that reduces systemic microemboli during open surgery: A prospective controlled study

Faleh Al-Rashidi, MDa, Sten Blomquist, MD, PhDb, Peter Höglund, MD, PhDc, Carl Meurling, MD, PhDd, Anders Roijer, MD, PhDd, Bansi Koul, MD, PhDa,*

a Department of Cardiothoracic Surgery, University Hospital Lund, Sweden
b Department of Cardiothoracic Anesthesiology, University Hospital Lund, Sweden
c Department of Clinical Research and Competence Center, University Hospital Lund, Sweden
d Department of Cardiology, University Hospital Lund, Sweden

Received for publication November 24, 2008; revisions received January 16, 2009; accepted for publication February 20, 2009.

* Address for reprints: Bansi Koul, MD, PhD, Department of Cardiothoracic Surgery, University Hospital Lund, 221 85 Lund, Sweden. (Email: bansi.koul{at}skane.se).

Objective: We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits.

Methods: Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion, and ventilation of lungs during de-airing [study group]). Transesophageal echocardiography and transcranial Doppler continually monitored the air emboli during the de-airing period and for 10 minutes after termination of the cardiopulmonary bypass.

Results: The amount of air embolism as observed on echocardiography and the number of microembolic signals as recorded by transcranial Doppler were significantly less in the study group during the de-airing time (P < .001) and the first 10 minutes after termination of cardiopulmonary bypass (P < .001). Further, the de-airing time was significantly shorter in the study group (10 vs 17 minutes, P < .001).

Conclusion: The de-airing technique evaluated in this study is simple, reproducible, controlled, safe, and effective. Moreover, it is cost-effective because the de-airing time is short and no extra expenses are involved.

Abbreviations and Acronyms CPB = cardiopulmonary bypass; LV = left ventricle; MES = microembolic signals; TCD = transcranial Doppler; TEE = transesophageal echocardiography






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