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[Antifoaming agent microembolism in patients undergoing extracorporeal circulation. Its frequency in post mortem
L Suchil Bernal1, N Hernández Rodríguez, J Hurtado
1Departamento de Patología, Instituto Nacional de Cardiología, México.
Abstract:
Antifoam microembolisms in patients that undergo open heart surgery, represent a risk for postoperative complications. We decided to study its frequency in an autopsy population of patients who died after heart surgery. Forty-five patients were selected and histological sections from the kidneys were studied under light microscopy, scanning electron microscopy and X-ray microanalysis. Thirty-six cases (80%) showed microemboli in the glomerular capillaries lumens. There was a positive correlation between the number of particles found and the length of the surgery. Microemboli were composed of an amorphous fraction and a particulated one composed of silicon. In vitro experimentation demonstrated that the particles are capable to induce cell lysis in a dose related manner. They also are susceptible of been phagocitated by macrophages. We conclude that bubble oxygenator are capable to induce microembolisms in a high percentage of the cases studied. Components of the microemboli are cytotoxic. Therefore microembolisms could be participating in the morbidity of patients subjects to cardiopulmonary bypass.
Insights
Antifoam microembolisms, a complication of open heart surgery, were found in 80% of autopsy cases. These silicon-based particles, linked to surgery length, are cytotoxic and may increase patient morbidity.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Materials Science
Context:
- Open heart surgery patients face risks of postoperative complications.
- Antifoam microembolisms are a potential, understudied complication.
- Autopsy studies offer insights into surgical outcomes.
Purpose:
- To determine the frequency of antifoam microembolisms in patients who died after heart surgery.
- To analyze the composition and characteristics of these microemboli.
- To investigate the potential impact of microemboli on patient morbidity.
Summary:
- Eighty percent of 45 autopsy cases showed microemboli in kidney glomerular capillaries.
- A positive correlation was observed between particle count and surgery duration.
- Microemboli comprised amorphous and silicon-based particulate matter.
- In vitro tests revealed particles induce dose-dependent cell lysis and are phagocytosed by macrophages.
Impact:
- Bubble oxygenators are implicated in inducing microembolisms in a high percentage of cases.
- The cytotoxic nature of microemboli components suggests a role in patient morbidity.
- Findings highlight the need for strategies to mitigate microembolism during cardiopulmonary bypass.