Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial.
OBJECTIVE
We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique.


METHODS
Twenty patients undergoing elective open aortic valve surgery were randomized prospectively to the Lund technique (Lund group, n = 10) or the carbon dioxide insufflation technique (carbon dioxide group, n = 10). Both groups were monitored intraoperatively during de-airing and for 10 minutes after weaning from cardiopulmonary bypass by transesophageal echocardiography and online transcranial Doppler for the severity and the number of gas emboli, respectively. The systemic arterial partial pressure of carbon dioxide and pH were also monitored in both groups before, during, and after cardiopulmonary bypass.


RESULTS
The severity of gas emboli observed on transesophageal echocardiography and the number of microembolic signals recorded by transcranial Doppler were significantly lower in the Lund group during the de-airing procedure (P = .00634) and in the first 10 minutes after weaning from cardiopulmonary bypass (P = .000377). Furthermore, the de-airing time was significantly shorter in the Lund group (9 vs 15 minutes, P = .001). The arterial pH during the cooling phase of cardiopulmonary bypass was significantly lower in the carbon dioxide group (P = .00351), corresponding to significantly higher arterial partial pressure of carbon dioxide (P = .005196) despite significantly higher gas flows (P = .0398) in the oxygenator throughout the entire period of cardiopulmonary bypass.


CONCLUSIONS
The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred.
Al-Rashidi
Faleh
F
Department of Cardiothoracic Surgery, Skane University Hospital in Lund, University of Lund, Sweden.
Landenhed
Maya
M
Blomquist
Sten
S
Höglund
Peter
P
Karlsson
Per-Axel
PA
Pierre
Leif
L
Koul
Bansi
B
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000191:economics; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003362:Cost-Benefit Analysis; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D002245:Carbon Dioxide