RESUMO
BACKGROUND: During cardiac surgery the use of a minimal extracorporeal circulation (MiECC) system may reduce the adverse effects for the patient. This is probably caused by reduced inflammation and hemodilution. For the use of a MiECC circuit, a venous bubble trap (VBT) is warranted for safety reasons. The aim of this study was to assess if an arterial filter with a small prime volume has the same (or better) air removal capacities as a VBT in a MiECC circuit and subsequentially may be used as an alternative. METHODS: In an in vitro study, air removal properties were compared between the arterial filter and three VBT's on the market, VBT160 (Getinge), VBT 8 (LivaNova and VARD (Medtronic). In a MiECC circuit, the filter devices were placed in a venous position and challenged with massive and micro air. Gaseous microemboli (GME) were measured with a bubble counter proximal and distal of the VBT device. RESULTS: More than 99.9 % of the air was removed after a bolus air challenge by all VBT's. Both the VARD and the AF100 showed better GME removal properties (not significant for the AF100) compared to the other devices. All filters showed GME generation after a challenge with massive air. Compared to the other filters, only the VARD showed no passing of larger bubbles when a volume of 50 mL of air was present in the filter. CONCLUSIONS: The AF100 seems to be a safe and low prime alternative for use in a MiECC system as a venous air trap. A word of caution, placement of the AF100 arterial filter in the venous line is off label use.
RESUMO
Gaseous microemboli (GME) may originate from the extracorporeal circuit and enter the arterial circulation of the patient. GME are thought to contribute to cerebral deficit and to adverse outcome after cardiac surgery. The arterial filter is a specially designed component for removing both gaseous and solid microemboli. Integration of an arterial filter with an oxygenator is a contemporary concept, reducing both prime volume and foreign surface area. This study aims to determine the air-handling properties of four contemporary oxygenator devices with an integrated arterial filter. Two oxygenator devices, the Capiox FX25 and the Fusion, showed significant increased volume of GME reduction rates (95.03 ± 3.13% and 95.74 ± 2.69%, respectively) compared with both the Quadrox-IF (85.23 ± 5.84%) and the Inspire 6F M (84.41 ± 12.93%). Notably, both the Quadrox-IF and the Inspire 6F M as well as the Capiox FX 25 and the Fusion showed very similar characteristics in volume and number reduction rates and in detailed distribution properties. The Capiox FX25 and the Fusion devices showed significantly increased number and volume reduction rates compared with the Quadrox-IF and the Inspire 6F M devices. Despite the large differences in design of all four devices, our study results suggest that the oxygenator devices can be subdivided into two groups based on their fibre design, which results in screen filter (Quadrox-IF and Inspire 6F M) and depth filter (Capiox FX25 and Fusion) properties. Depth filter properties, as present in the Capiox FX25 and Fusion devices, reduced fractionation of air and may ameliorate GME removal.