Intra-aortic filtration: capturing particulate emboli during aortic cross-clamping.
Particulate emboli are an important factor in the development of complications after cardiac surgery. The use of an intra-aortic filter during aortic declamping has proved safe and effective in reducing the incidence of embolic complications. Because aortic cross-clamping is also associated with the risk of embolism, we measured the release of particulate emboli at the time of aortic cross-clamping and at declamping. We deployed intra-aortic filters (Edwards EMBOL-X Slim Protection System) at 2 different times during 15 consecutive cardiac procedures with cardiopulmonary bypass. Filter A was inserted before aortic cross-clamping and left in place for a mean time of 3 minutes, and Filter B was inserted before aortic declamping for a mean of 17 minutes. An independent institution performed histopathologic examination. All filters captured particulate emboli, independent of the patients' degree of proximal aortic atherosclerotic disease. Macroscopy showed that Filter A captured more particles (mean, 70 +/- 2.6) in 7 of 15 patients (46.7%), Filter B captured more particles (mean, 6.7 +/- 2.6) in 5 of 15 patients (33.3%), and the filters captured the same number in 3 of 15 patients (20%). Microscopy showed that both filters captured fibrous atheroma or fibrous cap in 10 of 15 patients. We observed no complications related to the use of the filters. Aortic cross-clamping is associated with a high risk of embolism. We suggest that optimal protection against embolism during cardiac surgery can be achieved by applying intra-aortic filtration not only before aortic declamping but also before aortic cross-clamping.
Christenson
Jan T
JT
Department of Cardiovascular Surgery, University Hospital of Geneva, 24 rue Micheli-duCrest, CH-1211 Geneva 14, Switzerland. jan.christenson@hcuge.ch
Vala
Dominique L
DL
Licker
Marc
M
Sierra
Jorge
J
Kalangos
Afksendiyos
A
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D050197:Atherosclerosis / Q000150:complications; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005374:Filtration / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome