Capture of particulate emboli during cardiac procedures in which aortic cross-clamp is used. International Council of Emboli Management Study Group.
BACKGROUND
Previous studies have shown that atheroemboli are associated with neurologic complications following cardiac operation. Additionally, it has been demonstrated that embolization is closely related to the application and removal of ascending aortic cross-clamps.


METHODS
A prospective registry of 304 patients was initiated to describe patient selection, procedures, particulate capture, and clinical outcomes after intraaortic filtration in patients undergoing cardiac surgical procedures with cardiopulmonary bypass and median sternotomy. Prior to the removal of the cross-clamp, the intraaortic filter (EMBOL-X Inc, Mountain View, CA) was deployed and left in place until the patient was weaned from extracorporeal circulation. Upon removal, filters were fixed in formalin and shipped to a core laboratory for examination.


RESULTS
Mean patient age was 68 years (range 25 to 88 years), 40% had ascending aortic calcification, 59% of the procedures were coronary artery bypass grafting (CABG), 20% were valve replacement or repair, and 12% were a combination of CABG and valve surgery. Aortic cross-clamps were used in nearly all cases (302 of 304 patients); partial clamps were used in 84% of the CABG procedures. To date, 243 filters have been examined. Sixty-two percent of the filters analyzed revealed fibrous atheroma, 2% grumous atheroma, and 6% epiaortic debris. Platelet and fibrin strands were found in 52% of the filters and 22% contained evidence of thrombus or red blood cells.


CONCLUSIONS
These findings from the International Council of Emboli Management Registry confirm that particulates are released during cardiac surgical procedures using the aortic cross-clamp. Continued observational and randomized studies are necessary to confirm the clinical relevance of particulate extraction.
Harringer
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Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany. harringer@thg.mh-hannover.de
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004617:Embolism / Q000517:prevention & control*; D005374:Filtration; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery