The embolic potential of liquid fat in pericardial suction blood, and its elimination

Diffuse brain damage is a complex problem in cardiac surgery postoperatively. Liquid fat from recycled pericardial suction blood (PSB) is an embolic source. PSB can be discarded, but the recycling can be life saving, and methods have been developed to remove the fat. Blood washing by centrifugation is suggested to be the most effective method. In retained PSB, fat also separates without centrifugation, which is a novel and simple approach. Alternatively, inline fat filtration is easily accomplished but its effectiveness has been questioned. The present study aimed to investigate this phenomenon. Fat was heat extracted from retrieved pericardial fat tissue of coronary artery bypass graft (CABG) patients (n = 6), and was mixed, 1.25%, with postoperative mediastinal-shed blood. The mixture was filtered using a LipiGuard SB at constant flow rate. The filtration was scaled down to 3 mL and performed under temperature control, 37 degrees C, 20 degrees C and 10 degrees C. At these temperatures fat removal was 46.9 +/- 6.1%, 61.5 +/- 7.0% and 76.8 +/- 5.0%, respectively, with a statistical difference of P = 0.001. The improved fat removal at low temperature dramatically increased filtration pressures (P < 0.001) and caused haemolysis (P = 0.018). It is concluded that fat filtration is technically difficult. Cooling of blood increases fat extraction, but with negative side effects due to filter occlusion.