Particulate emboli capture by an intra-aortic filter device during cardiac surgery

Hermann Reichenspurner, Jose A. Navia, Gerald Berry, Robert C. Robbins, Denise Barbut, Jeffrey P. Gold, Bruno Reichart

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Objective: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. Results: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatous material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true thrombus and/or blood clot, 7% (n = 3) with normal Vessel wall, and 2% (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. Conclusion: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.

Original languageEnglish (US)
Pages (from-to)233-241
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume119
Issue number2
DOIs
StatePublished - Jan 1 2000

Fingerprint

Embolism
Thoracic Surgery
Cardiopulmonary Bypass
Nervous System
Equipment and Supplies
Thrombosis
Blood Platelets
Safety
Sternotomy
Atherosclerotic Plaques
Fibrin
Aorta
Histology
Hemodynamics
Stroke
Cholesterol
Electrons
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Particulate emboli capture by an intra-aortic filter device during cardiac surgery. / Reichenspurner, Hermann; Navia, Jose A.; Berry, Gerald; Robbins, Robert C.; Barbut, Denise; Gold, Jeffrey P.; Reichart, Bruno.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 119, No. 2, 01.01.2000, p. 233-241.

Research output: Contribution to journalArticle

Reichenspurner, Hermann ; Navia, Jose A. ; Berry, Gerald ; Robbins, Robert C. ; Barbut, Denise ; Gold, Jeffrey P. ; Reichart, Bruno. / Particulate emboli capture by an intra-aortic filter device during cardiac surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2000 ; Vol. 119, No. 2. pp. 233-241.
@article{c2f00783c8774e62be1132fef4c030c4,
title = "Particulate emboli capture by an intra-aortic filter device during cardiac surgery",
abstract = "Objective: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. Results: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66{\%} (n = 29) showed evidence of atheromatous material, 36{\%} (n = 16) with platelet-fibrin, 25{\%} (n = 11) with true thrombus and/or blood clot, 7{\%} (n = 3) with normal Vessel wall, and 2{\%} (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. Conclusion: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.",
author = "Hermann Reichenspurner and Navia, {Jose A.} and Gerald Berry and Robbins, {Robert C.} and Denise Barbut and Gold, {Jeffrey P.} and Bruno Reichart",
year = "2000",
month = "1",
day = "1",
doi = "10.1016/S0022-5223(00)70178-4",
language = "English (US)",
volume = "119",
pages = "233--241",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Particulate emboli capture by an intra-aortic filter device during cardiac surgery

AU - Reichenspurner, Hermann

AU - Navia, Jose A.

AU - Berry, Gerald

AU - Robbins, Robert C.

AU - Barbut, Denise

AU - Gold, Jeffrey P.

AU - Reichart, Bruno

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Objective: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. Results: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatous material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true thrombus and/or blood clot, 7% (n = 3) with normal Vessel wall, and 2% (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. Conclusion: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.

AB - Objective: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. Results: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatous material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true thrombus and/or blood clot, 7% (n = 3) with normal Vessel wall, and 2% (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. Conclusion: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.

UR - http://www.scopus.com/inward/record.url?scp=0033952279&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033952279&partnerID=8YFLogxK

U2 - 10.1016/S0022-5223(00)70178-4

DO - 10.1016/S0022-5223(00)70178-4

M3 - Article

C2 - 10649198

AN - SCOPUS:0033952279

VL - 119

SP - 233

EP - 241

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -