Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence
<i>Background and Objectives:</i> In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which ca...
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2024-12-01
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| author | Ignazio Condello Giuseppe Speziale Flavio Fiore Giuseppe Nasso |
| author_facet | Ignazio Condello Giuseppe Speziale Flavio Fiore Giuseppe Nasso |
| author_sort | Ignazio Condello |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which can be insidious and increase the risk of cerebral or myocardial complications. This retrospective study compares the effectiveness of the use of irrigation mist and CO<sub>2</sub> versus a direct CO<sub>2</sub> blower without irrigation in terms of visualization, postoperative fibrillation, and micro-embolic gas activity. <i>Materials and Methods:</i> The study involved 40 patients who underwent on-pump CABG, with 20 patients assigned to the irrigation mist and CO<sub>2</sub> group (ClearView™) and 20 to the direct CO<sub>2</sub> blower group. Primary outcomes included the quality of intraoperative visualization, the incidence of fibrillation at aortic de-clamping, and the presence of micro-embolic gas activity detected via transesophageal echocardiography (TEE) in the cardiac chambers. <i>Results:</i> Patients in the irrigation mist and CO<sub>2</sub> group experienced superior visualization and reduced tissue desiccation. Fibrillation at the time of aortic de-clamping occurred in two patients (10%) using the irrigation mist and CO<sub>2</sub>, compared to eight patients (40%) using the direct CO<sub>2</sub> blower. Additionally, TEE monitoring revealed lower levels of micro-embolic gas activity in the irrigation mist and CO<sub>2</sub> group, indicating a potential reduction in gas embolization risk. <i>Conclusions:</i> The irrigation mist and CO<sub>2</sub> system not only provides enhanced visualization during CABG but also significantly reduces the incidence of fibrillation during aortic de-clamping and micro-embolic gas activity. These findings suggest improved patient safety and outcomes, highlighting the irrigation mist and CO<sub>2</sub> system as a potentially safer alternative to direct CO<sub>2</sub> blowing in the context of myocardial revascularization. |
| format | Article |
| id | doaj-art-9948cbeef1c94a5f86bc24b2f131cdb1 |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-9948cbeef1c94a5f86bc24b2f131cdb12025-08-20T02:43:38ZengMDPI AGMedicina1010-660X1648-91442024-12-016012203510.3390/medicina60122035Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity IncidenceIgnazio Condello0Giuseppe Speziale1Flavio Fiore2Giuseppe Nasso3Department of Cardiac Surgery, Anthea Hospital GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, ItalyDepartment of Cardiac Surgery, Anthea Hospital GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, ItalyDepartment of Cardiac Surgery, Anthea Hospital GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, ItalyDepartment of Cardiac Surgery, Anthea Hospital GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy<i>Background and Objectives:</i> In coronary artery bypass grafting (CABG) on pump, achieving optimal visualization is critical for surgical precision and safety. The use of blowers to clear the CABG anastomosis poses risks, including the formation of micro-embolic gas bubbles, which can be insidious and increase the risk of cerebral or myocardial complications. This retrospective study compares the effectiveness of the use of irrigation mist and CO<sub>2</sub> versus a direct CO<sub>2</sub> blower without irrigation in terms of visualization, postoperative fibrillation, and micro-embolic gas activity. <i>Materials and Methods:</i> The study involved 40 patients who underwent on-pump CABG, with 20 patients assigned to the irrigation mist and CO<sub>2</sub> group (ClearView™) and 20 to the direct CO<sub>2</sub> blower group. Primary outcomes included the quality of intraoperative visualization, the incidence of fibrillation at aortic de-clamping, and the presence of micro-embolic gas activity detected via transesophageal echocardiography (TEE) in the cardiac chambers. <i>Results:</i> Patients in the irrigation mist and CO<sub>2</sub> group experienced superior visualization and reduced tissue desiccation. Fibrillation at the time of aortic de-clamping occurred in two patients (10%) using the irrigation mist and CO<sub>2</sub>, compared to eight patients (40%) using the direct CO<sub>2</sub> blower. Additionally, TEE monitoring revealed lower levels of micro-embolic gas activity in the irrigation mist and CO<sub>2</sub> group, indicating a potential reduction in gas embolization risk. <i>Conclusions:</i> The irrigation mist and CO<sub>2</sub> system not only provides enhanced visualization during CABG but also significantly reduces the incidence of fibrillation during aortic de-clamping and micro-embolic gas activity. These findings suggest improved patient safety and outcomes, highlighting the irrigation mist and CO<sub>2</sub> system as a potentially safer alternative to direct CO<sub>2</sub> blowing in the context of myocardial revascularization.https://www.mdpi.com/1648-9144/60/12/2035coronary artery bypass grafting (CABG)ClearView™ Blower/MisterCO<sub>2</sub> blowermicro-embolic gas activitytransesophageal echocardiography (TEE)aortic de-clamping |
| spellingShingle | Ignazio Condello Giuseppe Speziale Flavio Fiore Giuseppe Nasso Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence Medicina coronary artery bypass grafting (CABG) ClearView™ Blower/Mister CO<sub>2</sub> blower micro-embolic gas activity transesophageal echocardiography (TEE) aortic de-clamping |
| title | Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence |
| title_full | Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence |
| title_fullStr | Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence |
| title_full_unstemmed | Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence |
| title_short | Comparative Analysis of Irrigation Mist and CO<sub>2</sub> vs. Direct CO<sub>2</sub> Blower in On-Pump Coronary Artery Bypass Grafting Anastomosis: Efficacy, Efficiency, and Fibrillation upon De-Clamping and Micro-Embolic Gas Activity Incidence |
| title_sort | comparative analysis of irrigation mist and co sub 2 sub vs direct co sub 2 sub blower in on pump coronary artery bypass grafting anastomosis efficacy efficiency and fibrillation upon de clamping and micro embolic gas activity incidence |
| topic | coronary artery bypass grafting (CABG) ClearView™ Blower/Mister CO<sub>2</sub> blower micro-embolic gas activity transesophageal echocardiography (TEE) aortic de-clamping |
| url | https://www.mdpi.com/1648-9144/60/12/2035 |
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