Intra-aortic filtration: capturing particulate emboli during aortic cross-clamping

Particulate emboli are an important factor in the development of complications after cardiac surgery. The use of an intra-aortic filter during aortic declamping has proved safe and effective in reducing the incidence of embolic complications. Because aortic cross-clamping is also associated with the risk of embolism, we measured the release of particulate emboli at the time of aortic cross-clamping and at declamping. We deployed intra-aortic filters (Edwards EMBOL-X Slim Protection System) at 2 different times during 15 consecutive cardiac procedures with cardiopulmonary bypass. Filter A was inserted before aortic cross-clamping and left in place for a mean time of 3 minutes, and Filter B was inserted before aortic declamping for a mean of 17 minutes. An independent institution performed histopathologic examination. All filters captured particulate emboli, independent of the patients' degree of proximal aortic atherosclerotic disease. Macroscopy showed that Filter A captured more particles (mean, 70 +/- 2.6) in 7 of 15 patients (46.7%), Filter B captured more particles (mean, 6.7 +/- 2.6) in 5 of 15 patients (33.3%), and the filters captured the same number in 3 of 15 patients (20%). Microscopy showed that both filters captured fibrous atheroma or fibrous cap in 10 of 15 patients. We observed no complications related to the use of the filters. Aortic cross-clamping is associated with a high risk of embolism. We suggest that optimal protection against embolism during cardiac surgery can be achieved by applying intra-aortic filtration not only before aortic declamping but also before aortic cross-clamping.