Ann Thorac Surg 2000;70:1300
© 2000 The Society of Thoracic Surgeons
Original articles: cardiovascular
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DR CLINTON E BAISDEN (Temple, TX): This is a fascinating study. I first gained interest in this when I attended the Outcomes ’99 meeting in Key West, Florida, where your group presented a lot of data concerning this and other things. The question I have at this point is: has any attempt been made to recover any of these SCADs to see exactly what type of lipids they contain? I was wondering which you thought was more important, the volume of lipids that get transposed to the brain or the type of lipids that make it there?
DR KINCAID: To answer your first question, we currently have ongoing studies to determine the exact composition of this lipid material. This work is still in progress. We do know at this time, however, that the lipid embolus appears to contain a high concentration of fatty acids and that it does stain for lipid using various histologic techniques.
To answer your second question concerning the importance of the volume versus the type of microembolus, I think both components are clinically important. Most of the human data studying emboli and neurologic deficits have been obtained from intraoperative Doppler studies, and fortunately, less from autopsy studies. We have seen that the Doppler detects many types of microemboli, including air, cholesterol debris, and lipid, and that the number of microemboli detected during operation does correlate with the number of postoperative neurologic deficits. We have also seen upregulation of biochemical markers of neuronal injury surrounding the lipid microembolus, thus suggesting a role for both volume and specific type of emboli as contributing to clinically apparent neurologic sequelae.
DR NEAL D. KON (Winston-Salem, NC): Ted, why the difference in the amount of microemboli with the two types of cell savers? Why does intermittent and continuous result in a difference?
DR KINCAID: In vitro, the Fresenius continuous-action cell saver has been shown to remove more lipid than the intermittent-action devices. In the intermittent devices, the lipid and other debris that is removed may remain in apposition with the filtered product for some period of time before autotransfusion. This may allow leeching of the waste product back into the concentrated red cell product. This period of stagnation does not occur in the continuous device.
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Processing scavenged blood with a cell saver reduces cerebral lipid microembolization
- Edward H. Kincaid, Timothy J. Jones, David A. Stump, William R. Brown, Dixon M. Moody, Dwight D. Deal, and John W. Hammon, Jr
Ann. Thorac. Surg. 2000 70: 1296-1300.
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