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Cannula design reduces particulate and gaseous emboli during cardiopulmonary bypass for coronary revascularization
Adrian L Lata1, John W Hammon, Dwight D Deal
1Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA. alata@wfubmc.edu
Insights
A novel arterial cannula significantly reduces embolic events during coronary artery bypass surgery. This innovation helps prevent neurocognitive deficits by minimizing atheroembolism, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Biomedical Engineering
Background:
- Neurocognitive deficits are a significant complication following coronary artery bypass surgery (CABG).
- Atheroembolism, caused by aortic manipulation and perfusion jets, is a primary contributor to these deficits.
- Reducing embolic debris is crucial for improving neurological outcomes post-CABG.
Purpose of the Study:
- To evaluate a novel arterial cannula designed to mitigate atheroembolism during CABG.
- To assess the impact of the new cannula on embolic load compared to standard cannulas.
- To determine if the cannula design reduces the risk of cerebral microemboli.
Main Methods:
- A new arterial cannula with a multi-outlet tip design was developed to diffuse flow and reduce shear stress.
- Twenty patients undergoing isolated CABG were instrumented with the new cannula and an Embolus Detection and Classification transducer.
- Embolic counts were compared to a historical cohort of 43 patients who received standard open-tip arterial cannulas.
Main Results:
- The new cannula group exhibited significantly lower total embolic counts (20±25) compared to the standard cannula group (174±378).
- Gaseous embolic counts were markedly reduced with the new cannula (11±15 vs 95±211).
- Particulate embolic counts also showed a significant decrease in the new cannula group (9±11 vs 80±194).
Conclusions:
- The 3D cannula design effectively reduces the "sandblasting" effect of the perfusion jet.
- This innovative cannula design may redirect emboli away from the cerebral circulation, potentially lowering the incidence of post-operative neurocognitive deficits.
- The findings suggest a promising approach to enhance patient safety in cardiovascular procedures.
Purpose:
The incidence of neurocognitive deficits after coronary bypass surgery remains problematic, with atheroembolism being one of the major causes. External manipulation of aorta and the "sandblasting" effect of the high-velocity perfusion jet can cause dislodgement of atheromatous debris.
Description:
A new arterial cannula features a tip configuration that diffuses the flow through multiple outlets, providing reduced velocity and shear with one central and three diverted flow streams.
Evaluation:
Between March 2007 and July 2008 twenty patients having isolated coronary artery bypass operations were instrumented with an Embolus Detection and Classification transducer. These data were compared to 43 patients from a previous study using similar techniques except for a standard open-tip arterial cannula. Total embolic counts were markedly lower in the new cannula group (20±25 vs 174±378) as were both gaseous (11±15 vs 95±211) and particulate counts (9±11 vs 80±194).
Conclusions:
The select 3D cannula design reduces the sandblasting effect of the perfusion jet and, also, may direct emboli from the heart and cardiopulmonary bypass equipment away from the cerebral circulation.