Badreldin AMA, Albert AA, Ismail MM, Heldwein M, Doerr F, Bossert T, Lichtenberg A, Hekmat K. Gaseous emboli during off-pump surgery with T-graft technique, two different mechanisms.
Interact Cardiovasc Thorac Surg 2010;
10:766-9. [PMID:
20154069 DOI:
10.1510/icvts.2009.228270]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES
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.
CONCLUSION
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.
Collapse