AW: [HSF] Deairing the heart

[nand kejriwal]

Mark

Then I give hot shot reperfusion for 3 minutes, then K free blood for
3 minutes.  The root vent is clamped during reperfusion.

I assume you give hot shot retrograde. In that case, what is the advantage
in turning off the root vent? Do you get the head end low during the
deairing maneuvres?

I use more or less similar technique except that I do use CO2 in valve
cases. I agree most of the times I do not see air on TEE. But sometimes, I
do see air trapped at the apex or in the septum. Could it be due to lower
head end?

nand .

On 3/14/07, Mark Levinson <mmlevinson at hsforum.com> wrote:
>
>
> On Mar 2, 2007, at 6:02 AM, Dr. Roberto Battellini wrote:
>
> >
> I have a de-airing routine that I have been using unchanged for about
> 15 years, and with intraopTEE, I rarely see air in the chambers.
>
> I use a dual lumen aortic plegia catheter, with one channel on
> suction and the other as inflow for the plegia.   I do all my cases with
> a single cross clamp technique.
>
> Whether an open chamber (valve) or closed (CABG), I use the same de-
> airing routine in every single case without exception.   After the
> completion of the
> surgical repair, I ask the perfusionist to put suction on the aortic
> root catheter.    If I have an LV vent (via RSPV),  this line is
> clamped  initially.
>
> Then anesthesia gives a Valsalva breath at my request.    This
> dislodges air and blood from the pulmonary veins and displaces them
> into the LV.   I put my hand
> behind the LV and after the breath is let down, I gently compress the
> LV manually and massage the contents into the base of the aorta where
> they are retrieved by the
> root suction.
>
> I continue repeating these Valsalva breaths followed by LV manual
> compression for 8 or 10 repetitions.     If the heart is totally
> collapsed during this, I need
> to put some volume into the heart to wash the air through, so I
> impede venous return slightly to give volume to the RV and then
> compress the heart to massage the volume across to the LA and then
> repeat the Valsalva steps.      This also has the added benefit of re-
> expanding any atelectasis at the same time.
>
> Then I give hot shot reperfusion for 3 minutes, then K free blood for
> 3 minutes.  The root vent is clamped during reperfusion.  After
> releasing the cross-clamp, I place the aortic root (and if present,
> the RSPV vent) back on suction....
>
> After the heart is beating, I ask anesthesia to start ventilating at
> 50% of the anticipated tidal volumes while my vents are on
> suction.    At this stage TEE almost
> never shows air.     When going to 100% of tidal volume,
> occassionally we see a few bubbles, but nothing like what I am used
> to seeing on
> TEE during live teleconferences by the experts, etc.
>
> I do not use CO2.       With the technique described, air has been so
> minimal.
>
> Hope this helps....
>
> Mark M. Levinson, MD
> Founder, Editor-in-Chief,
> The Heart Surgery Forum
> WWW: <http://www.hsforum.com>
> Email: <mmLevinson at hsforum.com>
>
>
>
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