Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Embolism Research

Background:

• Particulate and gaseous microemboli (GME) are known complications of cardiac surgery, contributing to endothelial dysfunction and vascular issues.
• Cardiopulmonary bypass (CPB) is a significant source of embolic load during these procedures.
• Existing repriming techniques aim to mitigate embolic load, but novel approaches are needed for improved safety.

Purpose of the Study:

• To evaluate the safety of Hemetic antegrade repriming (HAR) concerning embolic load delivery during CPB.
• To quantify the volume and number of GME released during CPB using Doppler probes.
• To compare the embolic load between patients undergoing standard CPB and those receiving the HAR procedure.

Main Methods:

• A prospective, controlled study involving 115 patients undergoing cardiac surgery.
• Application of Doppler probes to the extracorporeal circuit to monitor GME during CPB.
• Standardized Hemetic antegrade repriming (HAR) procedure involving 300ml hemodilution, compared to a control group (CG).
• Management under strict normothermia with identical clinical conditions and minimized circuits for both groups.

Main Results:

• The HAR group delivered significantly less GME volume (0.08 ml) compared to the control group (0.28 ml; p = 0.004).
• High embolic volume exposure (>1 ml) was substantially lower in the HAR group (4.26%) versus the control group (30.36%; p = 0.001).
• HAR demonstrated a four-fold reduction in delivered embolic volume (coefficient, 0.24; p = 0.01), suggesting enhanced oxygenator GME clearance.

Conclusions:

• Hemetic antegrade repriming (HAR) is a safe procedure that does not increase embolic risk during cardiac surgery.
• HAR effectively reduces the embolic load delivered to patients undergoing CPB.
• The findings suggest HAR may improve GME clearance, potentially enhancing postoperative recovery.