Gaseous emboli during off-pump surgery with T-graft technique, two different mechanisms.
OBJECTIVE
Gaseous embolism is a possible complication during off-pump coronary surgery with the use of a blower and can cause ischemic injuries. We describe two different possible mechanisms of carbon-dioxide embolization.


METHODS
Out of 2196 coronary bypass surgeries, between 1 January 2007 and 31 December 2009, there were 977 off-pump operations. Two off-pump cases (0.2%) had gaseous (carbon-dioxide) emboli that migrated against blood stream proximally through T-anastomoses and then into the native coronary vessels. These emboli caused a temporary haemodynamic deterioration in other territories. Two types of T-anastomoses were included [saphenous vein on left internal thoracic artery (LITA) or right internal thoracic artery (RITA) on LITA].


RESULTS
Simple procedures and measurements were necessary but enough to regain haemodynamic stability. There was no effect on the postoperative outcome.


CONCLUSIONS
We have concluded that carbon-dioxide emboli can also cause massive but temporary haemodynamic deterioration during off-pump surgery despite higher solubility in blood. The blower should be used only when a bull-dog clamp is applied on the graft. Also, proper de-airing and flushing of grafts is very important and avoids consequences of the trapped small emboli.
Department of Cardio-Thoracic-Surgery, Friedrich Schiller University of Jena, Jena, Germany. akmalbadreldin@yahoo.com
Akmal M A
AM
Badreldin
Alexander A
AA
Albert
Mohamed M
MM
Ismail
Matthias
M
Heldwein
Fabian
F
Doerr
Torsten
T
Bossert
Artur
A
Lichtenberg
Khosro
K
Hekmat
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002245:Carbon Dioxide / Q000009:adverse effects / Q000494:pharmacology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
D002245:Carbon Dioxide