Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica

Abstract

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica Particulate emboli capture by an intra-aortic filter device during aortic valve replacement Abstract Objective: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA).Methods: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed.Results: There were no strokes or gross neurological events. There were no cases of postoperative renal failure." No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in two it was not possible to determine the nature of the particulates captured. Conclusion:The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis. Descriptors INTRODUCTIONStrokes are the third leading cause of death in developed countries and the main cause of physical disability [1]. Over the last few years, neurological lesions during heart surgery have received special attention from surgeons. About 3.8% of patients submitted to coronary artery bypass grafting and up to 10% of those who undergo aortic valve replacement suffer strokes [3,4].Neurological events are associated to substantial increases in mortality, hospitalization and costs over the medium and long terms. Much effort has been spent to minimize the risks of these complications. Although the causes of neurological complications are multifactorial, age and atherosclerosis have been identified as the main risk factors [5,6].Studies have evaluated the capacity and safety of intraaortic filters to capture fragments released in the intraoperative period of patients undergoing CABG. The results not only demonstrated the safety of the device but also its capacity to capture fragments in the intra-operative period and the histological composition of the fragments (predominantly of atheromatous origin), as well as identifying that aortic de-clamping was the moment of greatest risk [5].However specific studies to evaluate the use of this device in patients...

Cardiac Surgery-Associated Acute Kidney Injury

“…The system is designed to protect against embolism during cardiac surgery, reducing postoperative morbidity, in particular neurological and renal complications, as well as decreasing the hospital stay and mortality. Studies with larger samples are necessary in order to identify patients who would most benefit from the use of intra-aortic filters [90]. In regard to reduction of fat microembolism by use of a cell saver, the use of this technology is attractive but has not been proven as a method to prevent or reduce neurocognitive impairment or renal dysfunction.…”