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The effect of aortic cannula design on gaseous microemboli distribution into the head vessels : an in vitro study / Matt Hietpas.

by Hietpas, Matt.

Cardiopulmonary bypass -- Adverse effects

Blood -- Circulation, Artificial -- Complications.

Commerical products -- Testing.

Intracranial Embolism -- prevention & control

69 leaves : ill. ; 29 cm.

Thesis advisor: Dr. Ron Gerrits.

Committee members: Dr. Larry Fennigkoh, Mark Simmons.

Background -- Methods and materials -- Results -- Discussion -- Conclusion -- A: Raw data.

Cerebral microemboli are a common cause of neurological injury, Unfortunately, these microemboli are somewhat common in patients undergoing surgeries that utilize cardiopulmonary bypass (CPB). This is due to gaseous microemboli (GME) forming secondary to various perfusionist interventions. It is the goal of the perfusion community to limit these GME as much as possible, which requires an understanding of how each intervention affects GME production and distribution. The purpose of this study is to investigate the impact of aortic cannula design on the treatment of GME in the aorta and their distribution into the head vessels.

An in vitro cardiopulmonary bypass (CPB) circuit that included a cannulated aortic arch model was constructed to test the distribution of GME into the head vessels following injections of 1mL and 5mL of air into the arterial line of the circuit. Seven aortic cannulae of varying outlet shape, length, orifice area, and orifice configuration were tested at each bolus volume. GME volume and count were measured in the model's innominate, left common carotid, and left subclavian arteries using the Emboli Detection and Classification (EDAC) quantifier from Luna Innovations.

The results of this study demonstrate that aortic cannula design can significantly affect the GME count and total air volume distributed into the innominate and left common carotid arteries during CPB. The top performing cannulae are the Medtronic Select 3D with angled tip, diverted stream, and low pressure drop, and the Sarns D4 with angled tip, single end hole and low pressure drop. The Select 3D passed significantly less microembolic total volume, total count and counts in both the 0-40μm and 40-100μm ranges to the innominate artery, while the D4 passed significantly less microembolic total volume, total count and counts in the 0-40μm range to the left common carotid artery. Diversion of GME away from the head vessels could limit passage into the cerebral circulation and hence reduce the incidence or severity of post-CPB neurological dysfunction. Selection of the aortic cannulae for clinical use that demonstrate the ability to reduce the embolic volume and count distributed to the head vessels is yet another tool available to reduce the incidence of post-CPB morbidity.

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