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Contaminating fat in pericardial suction blood: a clinical, technical and scientific challenge
1Heart Center, Cardiothoracic Surgery Division, University Hospital of Umeå, Sweden. gunnar.engstrom@vll.se
Insights
Cardiac surgery can cause stroke and brain damage. This study presents a simple method to measure fat in pericardial suction blood (PSB), a potential cause, and discusses experimental challenges and solutions.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Biomedical Engineering
Background:
- Stroke and diffuse brain damage are significant risks following cardiac surgery.
- Cerebral fat microembolization from pericardial suction blood (PSB) is a proposed mechanism for diffuse brain damage.
- Standardized methods are needed to quantify fat content in PSB and mitigate experimental errors.
Purpose of the Study:
- To develop a simple method for measuring fat content in PSB.
- To identify and address experimental artifacts affecting fat measurement.
- To explore the use of PSB's unstable fat-blood suspension for a fat-separation system.
Main Methods:
- Fat content in PSB was measured using centrifugation to concentrate fat into a glass pipette tip.
- Experimental procedures, including static incubation and sample handling, were analyzed for artifact induction.
- The behavior of fat-blood suspensions and the use of soya oil as a reference were investigated.
Main Results:
- The developed method demonstrated a coefficient of variation of 9.5% in repeated experiments.
- PSB collected during coronary bypass surgery contained 0.22 +/- 0.04% fat, with 15 +/- 3% adhering to the collection bag.
- Identified artifacts include density separation and fat surface adhesion, influenced by experimental routines.
Conclusions:
- A simple, reliable method for quantifying fat in PSB was established.
- Standardization of experimental protocols is crucial to minimize artifacts in fat measurement.
- Understanding fat-blood suspension instability is key to designing effective fat-separation systems for potential clinical application.
Abstract:
Stroke and diffuse brain damage after cardiac surgery are too common. It is important to find means to reduce the incidence in view of future competition to surgery from less invasive procedures. Stroke is fairly well defined in clinical terms and with several identified mechanisms. Diffuse brain damage is less well defined and more complex in nature. One suggested mechanism is from cerebral fat microembolization of retrieved pericardial suction blood (PSB). The present study aimed to describe a simple method to measure fat content of PSB, how experimental artefacts interfere with the results, and how the unstable character of a fat-blood suspension can be used to design a simple fat-separation system. The quantity of small amounts of fat can be amplified by centrifugation to the tapered tip of a standard glass pipette. The coefficient of variation after repeated experiments was 9.5%. PSB after coronary bypass surgery contained 0.22 +/- 0.04% fat of which 15 +/- 3% was bound to the surface of the plastic collecting bag. Experimentation requires standardized routines. Static incubation, blood-fat mixing routines, and transfer steps of blood samples between syringes induce substantial artefacts from spontaneous density separation and surface-adhesion of fat. Soya oil is a common reference substance replacing human fat in technical laboratory science, but is associated with artefacts of its own. These artefacts cause problems during experimentation but the oil is a good resource in the design of a simple fat-separation system.
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