AW: [HSF] Deairing the heart

[prasannasimha]

My method is virtually the same though I always fill the right heart 
then compress the RV to allow blood to enter the PA , the anesthetist 
blows to displace blood to the LA/LV and then massage the heart to 
evacuate air.If you have a beating heart at that time with continuous 
retrograde it seems to clear things better.
Prasanna

Mark Levinson 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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