title: A novel emboli protection cannula during cardiac surgery: in vitro results.
abstract: OBJECTIVE
  Intraoperative cerebral events are mainly caused by emboli generated by operative manipulation of the aorta. This study aimed to delineate the distribution profiles of emboli with 2 widely used cannulae and a third novel research cannula that simultaneously produces forward flow and backward suction to extract emboli from the distal aorta during cardiac surgery.
  
  
  METHODS
  The current in vitro study used a silicone model of the aortic arch and branches. The main outcome measure was the distribution profile of embolic particles of different sizes to the aortic branches; 2 commercial cannulae and a third novel cannula with and without suction were used. The research cannula was examined at different suction levels and the amount of particles retrieved was measured.
  
  
  RESULTS
  For the research curved-tip cannula, most of the small emboli were released into the brachiocephalic trunk in the model (P < .05). For the straight-tip cannula, most of the small emboli were released into the descending aorta (P < .05). Regarding the commercial curved-tipped cannula, most of the small emboli were released into the brachiocephalic trunk (47.14% ± 4.78%; P < .05) and the medium and large emboli were predominantly released into the descending aorta. Using suction, the research cannula retrieved most of the emboli released into the aorta for all particle sizes (50%-83%; P < .05).
  
  
  CONCLUSIONS
  A straight-tip cannula may be safer in terms of cerebral embolic consequences during cardiac surgery. Furthermore, the use of the research aortic cannula may be beneficial in the cardiac surgery setting by reducing the postoperative risk for stroke.
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Liran
authors: L
authors: Shani
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Oved
authors: O
authors: Cohen
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Ziv
authors: Z
authors: Beckerman
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Idit
authors: I
authors: Avrahami
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Rony-Reuven
authors: RR
authors: Nir
authors: Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel. Electronic address: g_bolotin@rambam.health.gov.il.
authors: Gil
authors: G
authors: Bolotin
mesh_terms: D001011:Aorta / Q000601:surgery*; D062906:Cardiac Catheters; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D057505:Embolic Protection Devices; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control*; D008422:Materials Testing; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D010316:Particle Size; D011474:Prosthesis Design; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013396:Suction