Use of Carbon dioxide versus air blower in on-pump beating-heart coronary artery bypass surgery

Document Type : Original Article

Authors

1 Professor of Department of cardiovascular surgery, faculty of medicine, Mashhad university of medical sciences, Mashhad, Iran

2 Cardiovascular Surgeon, Faculty of Medicine ,Department Of Cardiovascular Surgery, Faculty Of Medicine, Mashhad University Of Medical Sciences, Mashhad, Iran

3 Department of Cardiovascular surgery, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction:  The use of carbon dioxide blower has been recognized as the standard of care in patients undergoing beating coronary artery bypass grafting (CABG) due to higher solubility and lower risk of embolization. On the other hand, the compressed air blower has gone out of use since air can be easily trapped and is less soluble which can cause coronary embolism. The present study aimed to compare the outcomes of patients undergoing on-pump beating CABG using CO2, as opposed to an air blower.
Materials and Methods: A total number of 125 patients requiring coronary revascularization underwent on-pump beating CABG within February 2017-February 2018. In the current cross sectional study, 45 patients underwent CABG with CO2 blower and other patients were operated using air blower. The reported postoperative outcomes included mortality, low cardiac output state, malignant arrhythmia, postoperative myocardial infarction, blood transfusion, transient ischemic attack or stroke, intra-aortic balloon pump (IABP), as well as intensive care unit and hospital length of stay.
Results:Demographic characteristics of patients in two groups in terms of age, sex, risk factors, echocardiographic and angiography data were similar and demonstrated no significant difference. Patients' outcomes, such as cardiac arrhythmias, myocardial infarction, ICU and hospital stays, were also similar in both groups. In addition, the overall morbidity and hospital mortality showed no significant difference between the two groups.
Conclusion: Although the use of CO2 during beating CABG has been advocated with its theoretical advantages, no significant difference was observed between the two groups in terms of mortality and morbidity using CO2, as opposed to air blower.

Keywords

References

1.             Gulcan O, Turkoz R, Turkoz A, Caliskan E, Sezgin AT. On-pump/beating-heart myocardial protection for isolated or combined coronary artery bypass grafting in patients with severe left ventricle dysfunction: assessment of myocardial function and clinical outcome. Heart Surg Forum. 2005; 8:E178-82.
2.             Mark DB, Newman MF. Protecting the brain in coronary artery bypass graft surgery. JAMA. 2002; 287:1448-50.
3.             Stanbridge RD, Hadjinikolaou LK. Technical adjuncts in beating heart surgery comparison of MIDCAB to off-pump sternotomy: a meta-analysis. Eur J Cardiothorac Surg. 1999; 16:S24-33.
4.             Duhaylongsod FG. Minimally invasive cardiac surgery defined. Arch Surg. 2000; 135:296-301.
5.             Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter study of perioperative ischemia research group and the ischemia research and education foundation investigators. N Engl J Med. 1996; 335:1857-63.
6.             Kuralay E. Massive systemic air embolism during off-pump coronary artery surgery. Eur J Cardiothorac Surg. 2009; 35:183-4.
7.             de Jaegere PP, Suyker WJ. Off-pump coronary artery bypass surgery. Heart. 2002; 88:313-8.
8.             Sasaguri S, Hosoda Y, Yamamoto S. Carbon dioxide gas blow for the safe visualization of coronary artery anastomosis. Ann Thorac Surg. 1995; 60:1861.
9.             Chassot PG, Van der Linden P, Zaugg M, Mueller X, Spahn D. Off-pump coronary artery bypass surgery: physiology and anaesthetic management. Br J Anaesth. 2004; 92:400-13.
10.          Wippermann J, Albes JM, Liebing K, Breuer M, Kaluza M, Strauch J, et al. Simple on-site assembled blower-mister device provides sufficient humidification and visualization in off-pump surgery. Ann Thorac Surg. 2006; 82:1134-6.
11.          Brown KM, Sabetai MM, Venn GE. Gas embolization from the left ventricle and aortic root: A possible side effect of high-flow gas insufflation during coronary artery surgery. Ann Thorac Surg. 2004; 78:387-8.
12.          Nollert G, Oberhoffer M, Reichart B, Vicol C. Combination of the HEARTSTRING proximal seal system with a blower mister: a possible source of gas emboli. J Thorac Cardiovasc Surg. 2003; 126:1192-4.
13.          Teoh KH, Panos AL, Harmantas AA, Lichtenstein SV, Salerno TA. Optimal visualization of coronary artery anastomoses by gas jet. Ann Thorac Surg. 1991; 52:564.
14.          Korkmaz AA, Guden M, Korkmaz F, Yuce M. Coronary air embolism in off-pump surgery caused by blower-mister device. J Card Surg. 2008; 23:583-5.
15.          Badreldin AM, Albert AA, Ismail MM, Heldwein M, Doerr F, Bossert T, et al. Gaseous emboli during off-pump surgery with T-graft technique, two different mechanisms. Interact Cardiovasc Thorac Surg. 2010; 10:766-9.
16.          Hong SW, Shim JK, Choi YS, Kim DH, Chang BC, Kwak YL. Prediction of cognitive dysfunction and patients’ outcome following valvular heart surgery and the role of cerebral oximetry. Eur J Cardiothorac Surg. 2008; 33:560-5.
17.          Svenarud P, Persson M, van der Linden J. Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation. 2004; 109:1127-32.
18.          Lee JH, Yoon SZ, Choi JY, Bahk JH, Jeon Y. Massive carbon dioxide embolism caused by a carbon dioxide blower during the repair of a coronary vein during off-pump coronary artery bypass. J Cardiothorac Vasc Anesth. 2007; 21:715-7.
 
 
 
 
 
 
 
Journal of Cardio-Thoracic Medicine
Volume 8, Issue 2
June 2020
Pages 633-638

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