De-airing Technique in Minimally Invasive Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HAODong , WANGChun-sheng , ZHUShi-jie , ZHANGZhi-qi

Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, P. R. China;

Corresponding author：

HAODong, Email: eastzhao15@126.com

Keywords：

Minimal invasive cardiac surgery; De-airing technique; Air embolism

DOI：

10.7507/1007-4848.20140230

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Objective To evaluate clinical outcomes of de-airing technique in minimally invasive cardiac surgery (MICS). Methods Fifty-six patients undergoing MICS in Zhongshan Hospital of Fudan University between June 2011 and June 2013 were recruited as a MICS group, including 31 male and 25 female patients with their age of 33-71 (57.3±7.2)years. Fifty-six patients who underwent mitral valvuloplasty via routine median sternotomy during the same period were recruited as the control group, including 27 male and 29 female patients with their age of 51-69 (53.7±6.8)years. Postoperative residual air in the heart, abnormal ECG findings, time to recovery of consciousness, cognitive function and neurological complications were compared between the 2 groups. Results There were 69.6% patients with mild residual air and 30.4% patients with moderate residual air in the heart of MICS group, and 73.2% patients with mild residual air and 26.8% patients with moderate residual air in the heart of the control group (P > 0.05). There was no statistical difference in the incidence of abnormal ECG findings between the 2 groups (32.1% vs. 26.8%, P > 0.05). Patients with better, good and bad postoperative cognitive function accounted for 85.7%, 12.5% and 1.8% in MICS group respectively, and 78.6%, 19.6% and 1.8% in the control group respectively (P > 0.05). There was no statistical difference in the incidence of neurological complications between the 2 groups (1.8% vs. 1.8%, P > 0.05). Conclusion With appropriate de-airing techniques, postoperative incidence of air embolism of MICS is comparable with that of conventional cardiac surgery via median sternotomy, and the risk of air embolism of MICS is not higher.

Citation： HAODong, WANGChun-sheng, ZHUShi-jie, ZHANGZhi-qi. De-airing Technique in Minimally Invasive Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 803-805. doi: 10.7507/1007-4848.20140230 Copy

1.	Law AD, Gulati A, Bhalla A. Air in the heart:what should one do? Am J Emerg Med, 2012, 30(8):1659, e1-e3.
2.	Neema PK, Pathak S, Varma PK, et al. Case 2--2007:Systemic air embolization after termination of cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2007, 21(2):288-297.
3.	Bou-Assaly W, Pernicano P, Hoeffner E. Systemic air embolism after transthoracic lung biopsy:a case report and review of literature. World J Radiol, 2010, 2(5):193-196.
4.	金海, 徐志云, 于伟勇, 等.微创小切口心脏瓣膜手术134例.中国胸心血管外科临床杂志, 2005, 12(4):237-239.
5.	Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock, 2009, 2(3):180-185.
6.	Petracek MR, Leacche M, Solenkova N, et al. Minimally invasive mitral valve surgery expands the surgical options for high-risks pati-ents. Ann Surg, 2011, 254(4):606-611.
7.	Baufreton C. Role of surgical factors in strokes after cardiac surgery. Arch Cardiovasc Dis, 2010, 103(5):326-332.
8.	Lombard FW, Welsby IJ, Booth JV. Systemic air embolism during off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2003, 17(3):403-404.
9.	Newcomb A, Frawley G, Fock A, et al. Hyperbaric oxygenation in the management of cerebral arterial gas embolism during cavopulmonary connection surgery. J Cardiothorac Vasc Anesth, 2008, 22(4):576-580.
10.	魏来, 沈金强, 王春生, 等.微创心脏瓣膜手术——单中心601例总结.心血管外科杂志:电子版, 2012, 1(1):17-22.
11.	Persson M, Svenarud P, Linden J, et al. What is the optimal device for carbon dioxide deairing of the cardiothoracic wound and how should it be positioned? J Cardiothorac Vasc Anesth, 2004, 18(2):180-184.
12.	Huang YY, Chen MR. Coronary air embolism during transcatheter closure of atrial septal defects. J Pediatr, 2014, 164(3):669.
13.	Mo A, Lin H, Wen Z, et al. Efficacy and safety of on-pump beating heart surgery. Ann Thorac Surg, 2008, 86(6):1914-1918.
14.	Rodriguez RA, Belway D. Comparison of two different extracorpo-real circuits on cerebral embolization during cardiopulmonary bypass in children. Perfusion, 2006, 21(5):247-253.
15.	Skidmore KL, Jones C, Dewet C. Flooding the surgical field with carbon dioxide during open heart surgery improves segmental wall motion. J Extra Corpor Technol, 2006, 38(2):123-127.
16.	Rodriguez RA, Rubens F, Belway D, et al. Residual air in the venous cannula increases cerebral embolization at the onset of cardiopulmonary bypass. Eur J Cardiothorac Surg, 2006, 29(2):175-180.
17.	Suematsu Y, Martinez JF, Wolf BK, et al. Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass:atrial septal defect closure in a swine model. J Thorac Cardiovasc Surg, 2005, 130(5):1348-1357.
18.	Woo YJ, Acker MA. Implantable ventricular assist device exchange with focused intravascular deairing techniques. Ann Thorac Surg, 2011, 91(1):306-307.
19.	Koul BL, Rashidi FA, Roijer A, et al. A new technique to reduce residual air emboli in open left cardiac surgery. J Thorac Cardiovasc Surg, 2009, 138(6):1438-1439.
20.	Schubert A, Deogaonkar A, Drummond JC. Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy. Anesth Analg, 2006, 102(5):1543-1547.
21.	Chaudhuri K, Lee GA, Storey E, et al. CO₂ pericardial insufflation for deairing in open chamber cardiac surgery and neurocognitive outcomes. Heart Lung Circul, 2011, 20(12):781.

1. Law AD, Gulati A, Bhalla A. Air in the heart:what should one do? Am J Emerg Med, 2012, 30(8):1659, e1-e3.
2. Neema PK, Pathak S, Varma PK, et al. Case 2--2007:Systemic air embolization after termination of cardiopulmonary bypass. J Cardiothorac Vasc Anesth, 2007, 21(2):288-297.
3. Bou-Assaly W, Pernicano P, Hoeffner E. Systemic air embolism after transthoracic lung biopsy:a case report and review of literature. World J Radiol, 2010, 2(5):193-196.
4. 金海, 徐志云, 于伟勇, 等.微创小切口心脏瓣膜手术134例.中国胸心血管外科临床杂志, 2005, 12(4):237-239.
5. Shaikh N, Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock, 2009, 2(3):180-185.
6. Petracek MR, Leacche M, Solenkova N, et al. Minimally invasive mitral valve surgery expands the surgical options for high-risks pati-ents. Ann Surg, 2011, 254(4):606-611.
7. Baufreton C. Role of surgical factors in strokes after cardiac surgery. Arch Cardiovasc Dis, 2010, 103(5):326-332.
8. Lombard FW, Welsby IJ, Booth JV. Systemic air embolism during off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2003, 17(3):403-404.
9. Newcomb A, Frawley G, Fock A, et al. Hyperbaric oxygenation in the management of cerebral arterial gas embolism during cavopulmonary connection surgery. J Cardiothorac Vasc Anesth, 2008, 22(4):576-580.
10. 魏来, 沈金强, 王春生, 等.微创心脏瓣膜手术——单中心601例总结.心血管外科杂志:电子版, 2012, 1(1):17-22.
11. Persson M, Svenarud P, Linden J, et al. What is the optimal device for carbon dioxide deairing of the cardiothoracic wound and how should it be positioned? J Cardiothorac Vasc Anesth, 2004, 18(2):180-184.
12. Huang YY, Chen MR. Coronary air embolism during transcatheter closure of atrial septal defects. J Pediatr, 2014, 164(3):669.
13. Mo A, Lin H, Wen Z, et al. Efficacy and safety of on-pump beating heart surgery. Ann Thorac Surg, 2008, 86(6):1914-1918.
14. Rodriguez RA, Belway D. Comparison of two different extracorpo-real circuits on cerebral embolization during cardiopulmonary bypass in children. Perfusion, 2006, 21(5):247-253.
15. Skidmore KL, Jones C, Dewet C. Flooding the surgical field with carbon dioxide during open heart surgery improves segmental wall motion. J Extra Corpor Technol, 2006, 38(2):123-127.
16. Rodriguez RA, Rubens F, Belway D, et al. Residual air in the venous cannula increases cerebral embolization at the onset of cardiopulmonary bypass. Eur J Cardiothorac Surg, 2006, 29(2):175-180.
17. Suematsu Y, Martinez JF, Wolf BK, et al. Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass:atrial septal defect closure in a swine model. J Thorac Cardiovasc Surg, 2005, 130(5):1348-1357.
18. Woo YJ, Acker MA. Implantable ventricular assist device exchange with focused intravascular deairing techniques. Ann Thorac Surg, 2011, 91(1):306-307.
19. Koul BL, Rashidi FA, Roijer A, et al. A new technique to reduce residual air emboli in open left cardiac surgery. J Thorac Cardiovasc Surg, 2009, 138(6):1438-1439.
20. Schubert A, Deogaonkar A, Drummond JC. Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy. Anesth Analg, 2006, 102(5):1543-1547.
21. Chaudhuri K, Lee GA, Storey E, et al. CO₂ pericardial insufflation for deairing in open chamber cardiac surgery and neurocognitive outcomes. Heart Lung Circul, 2011, 20(12):781.

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