Condello Ignazio, Speziale Giuseppe, Fiore Flavio, Nasso Giuseppe
Department of Cardiac Surgery, Anthea Hospital GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
Medicina (Kaunas). 2024 Dec 10;60(12):2035. doi: 10.3390/medicina60122035.
In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which can be insidious and increase the risk of cerebral or myocardial complications. This retrospective study compares the effectiveness of the use of irrigation mist and CO versus a direct CO blower without irrigation in terms of visualization, postoperative fibrillation, and micro-embolic gas activity. The study involved 40 patients who underwent on-pump CABG, with 20 patients assigned to the irrigation mist and CO group (ClearView™) and 20 to the direct CO blower group. Primary outcomes included the quality of intraoperative visualization, the incidence of fibrillation at aortic de-clamping, and the presence of micro-embolic gas activity detected via transesophageal echocardiography (TEE) in the cardiac chambers. Patients in the irrigation mist and CO group experienced superior visualization and reduced tissue desiccation. Fibrillation at the time of aortic de-clamping occurred in two patients (10%) using the irrigation mist and CO, compared to eight patients (40%) using the direct CO blower. Additionally, TEE monitoring revealed lower levels of micro-embolic gas activity in the irrigation mist and CO group, indicating a potential reduction in gas embolization risk. The irrigation mist and CO system not only provides enhanced visualization during CABG but also significantly reduces the incidence of fibrillation during aortic de-clamping and micro-embolic gas activity. These findings suggest improved patient safety and outcomes, highlighting the irrigation mist and CO system as a potentially safer alternative to direct CO blowing in the context of myocardial revascularization.
在体外循环冠状动脉搭桥术（CABG）中，实现最佳可视化对于手术的精确性和安全性至关重要。使用吹风机清除CABG吻合口存在风险，包括形成微栓塞气泡，这些气泡可能很隐匿，并增加脑或心肌并发症的风险。这项回顾性研究比较了在可视化、术后房颤和微栓塞气体活动方面，使用冲洗雾和二氧化碳与直接使用无冲洗的二氧化碳吹风机的效果。该研究纳入了40例行体外循环CABG的患者，其中20例被分配到冲洗雾和二氧化碳组（ClearView™），20例被分配到直接二氧化碳吹风机组。主要结局包括术中可视化质量、主动脉夹闭时房颤的发生率以及通过经食管超声心动图（TEE）检测到的心腔内微栓塞气体活动情况。冲洗雾和二氧化碳组的患者可视化效果更好，组织干燥程度降低。使用冲洗雾和二氧化碳时，主动脉夹闭时房颤发生在2例患者（10%），而使用直接二氧化碳吹风机时为8例患者（40%）。此外，TEE监测显示冲洗雾和二氧化碳组的微栓塞气体活动水平较低，表明气体栓塞风险可能降低。冲洗雾和二氧化碳系统不仅在CABG期间提供了更好的可视化，而且显著降低了主动脉夹闭时房颤的发生率和微栓塞气体活动。这些发现表明患者安全性和结局得到改善，突出了冲洗雾和二氧化碳系统在心肌血运重建中作为直接二氧化碳吹气潜在更安全替代方案的地位。
