Publication: Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial
Authors
Blanco-Morillo, J ; Salmerón, D ; Morillo-Cuadrado, DV ; Arribas-Leal, JM ; Puis, L ; Verdú-Verdú, A ; Martínez-Molina, M ; Tormos-Ruiz, E ; Sornichero-Caballero, A ; Ramírez-Romero, P ; Farina, P ; Cánovas-López, S
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Publisher
Lippincott Williams & Wilkins
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DOI
https://doi.org/10.1097/MAT.0000000000001776
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info:eu-repo/semantics/article
Description
© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity SocietyThis document is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
This document is the published version of a published work that appeared in final form in ASAIO Journal. To access the final edited and published work see https://doi.org/10.1097/MAT.0000000000001776
Abstract
Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08-0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation.
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Citation
ASAIO Journal 69(3):p 324-331, March 2023
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