Particulate emboli capture by an intra-aortic filter device during cardiacsurgery

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 en ter the central circulation, Methods: Patients undergoing cardiac surgery w ith cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intraaortic filtration. A novel intra-ao rtic filter device was inserted through a modified 24F arterial cannula imm ediately before releasing the crossclamp in 77 patients. Filters remained i n the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effec t on routine cardiopulmonary bypass operation and function. Results: The in sertion and removal of the intra-aortic filter were safe, easy, and unevent ful in most patients, Patient hemodynamics and bypass flow rates remained n ormal throughout the filter dwell period. No strokes or gross neurologic de fects were noted. Electron microscopic analysis of 12 filters revealed an i nsignificant degree of platelet adhesion on filter surfaces. Histology samp les (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatou s material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true throm bus and/or blood clot, 7% (n = 3) with normal vessel wall, and 2% (n = 1) w ith aggregates of cholesterol or grumous portion of atheromatous plaque. Co nclusion: The intra-aortic filter can be safely deployed and captures parti culate emboli, the predominant origin of which is atheromatous. The benefic ial effects of this device on neurologic outcomes have yet to be determined .