Ann Thorac Surg 1996;62:1537-1538
© 1996 The Society of Thoracic Surgeons
How To Do It
Simple System for Deairing the Heart After Cardiopulmonary Bypass
Richard P. Salzano, Jr, MD,
Vasant B. Khachane, MD
Division of Cardiothoracic Surgery, Department of Surgery, The Hospital of Saint Raphael, New Haven, Connecticut
Accepted for publication June 27, 1996.
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Abstract
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Air embolism remains a potential hazard of cardiopulmonary bypass. We describe a simple technique for deairing the heart that is inexpensive and requires no manipulation or extra cannulation of the heart.
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Introduction
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Air embolism is a potentially lethal complication of open heart operations. Intraoperative studies with transesophageal echocardiography have demonstrated retained intracardiac air bubbles in as many as 79% of valve operations [1]. Some studies have shown continued presence and ejection of air, even with strict attention to deairing, for extended periods of time after discontinuation of cardiopulmonary bypass [2, 3], when manual deairing techniques may be difficult to use. We have used a simple technique for deairing the heart after valve operations that uses the cardiopulmonary bypass circuit and cannulas, requiring no manipulation or extra cannulation of the heart.
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Technique
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After systemic heparinization, routine cannulation of the ascending aorta is performed with an Argyle straight 21F aortic perfusion catheter. The aortic cannula is connected to the arterial line of the cardiopulmonary bypass circuit with a Gish Biomedical (Irvine, CA) 3/8-inch x 3/8-inch connector with Luer-Lok, and an attached three-way stopcock on its sideport. Cannulation of the right atrium is performed with a two-stage venous cannula or bicaval cannulation, depending upon the type of operation. The venous line of the circuit similarly has an appropriately sized Gish Biomedical connector with Luer-Lok and attached three-way stopcock on its sideport. A needle aspiration catheter is placed in the aortic root, and a left ventricular vent is used when necessary.
Cardiopulmonary bypass is instituted, the heart is arrested with cold blood cardioplegia, and the valve operation is performed. Before and after cross-clamp removal, routine air clearing by left atrial and left ventricular aspiration following passive filling and by needle aspiration of the ascending aorta is performed until all obvious air is removed. Adequacy of deairing is assessed by transesophageal echocardiography when available. Once all apparent air is removed, the needle vent is removed.
Just before termination of cardiopulmonary bypass, a standard pressure transducer line is connected between the stopcocks of the connectors in the arterial and venous circuits. The stopcocks are opened, creating a small, controlled arteriovenous fistula between the aortic and venous cannulas (Fig 1
). Cardiopulmonary bypass is weaned and discontinued, the venous line is clamped at the pump, and ejected microbubbles can be visualized passing into the aortic cannula and through the fistula into the venous cannula as the heart fills and ejects. When the arterial cannula is clear and there are no further bubbles visualized (usually after a period of 1 to 5 minutes), the stopcocks are closed and the pressure line is removed. Protamine is given to reverse the heparin, and the arterial line can now be used for rapid transfusion.
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Comment
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This technique provides a simple and inexpensive method for removal of ejected intracardiac air after discontinuation of cardiopulmonary bypass. We believe that the large orifice of the aortic cannula and its position on the anterior surface of the aorta may be more efficient for air removal than a retained needle aspiration catheter. Furthermore, any potential introduction of air into the aorta from a dislodged or reversed needle aspiration catheter on suction is avoided. This system should not be relied upon exclusively for air removal, as air trapped around the aortic cannula near the intima may not be removed. However, its usefulness is strengthened by not having to add additional cannulas or needles to the system. We have used the technique primarily for valve operations, but it can be easily adapted to all cardiopulmonary bypass cases.
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Footnotes
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Address reprint requests to Dr Salzano, Cardiothoracic and Vascular Group, 175 Sherman Ave, New Haven, CT 06511.
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References
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- Oka Y, Inoue T, Hong Y, Sisto DA, Strom JA, Frater RWM. Retained intracardiac air. J Thorac Cardiovasc Surg 1986;91:329–38.[Abstract]
- Rodigas PC, Meyer FJ, Haasler GB, Dubroff JM, Spotnitz HM. Intraoperative 2-dimensional echocardiography: ejection of microbubbles from the left ventricle after cardiac surgery. Am J Cardiol 1982;50:1130–2.[Medline]
- Topol EJ, Humphrey LS, Borkon AM, et al. Value of intraoperative left ventricular microbubbles detected by transesophageal two-dimensional echocardiography in predicting neurologic outcome after cardiac operations. Am J Cardiol 1985;56:773–5.[Medline]
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Abstract
Introduction
