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Scand Cardiovasc J. 2010 Dec;44(6):367-72. doi: 10.3109/14017431.2010.501867. Epub 2010 Nov 11.

Size distribution of embolic material produced at aortic cross-clamp manipulation.

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  • 1Department of Surgical and Perioperative Science, Section for Hand and Plastic Surgery, Umeå University Hospital, Umeå, Sweden.

Abstract

OBJECTIVES:

The association between aortic atherosclerosis and neurological damage during cardiac surgery is well recognized. The purpose was here to analyze the size distribution of particles produced at cross-clamp manipulation of the ascending aorta.

DESIGN:

A human cadaveric aortic perfusion model of retrograde design was applied (n=27). With this model, washout samples were collected from the pressurized ascending aorta during cross clamp manipulation. Before the experiment, the aorta was flushed to remove debris and with a baseline sample collected. The cross-clamp was opened to collect ten repeated aliquots with dislodged particles. Collected washout samples were evaluated by digital image analysis and microscopy.

RESULTS:

Cross-clamping produced a significant output of particles, which was seen for size intervals of 1 mm and smaller (p=0.002 to p=0.022). In all size intervals the particle output correlated with the degree of overall aortic calcification (p=0.002 to p=0.025). The model generated substantially more small-size particles than large debris (p<0.010).

CONCLUSIONS:

Aortic clamping was here verified to dislodge aortic debris which correlated with the degree of observed calcification. Macroscopic particles were few. In contrast, cross-clamping produced substantial numbers of small-size particles. These findings emphasize microembolic risks associated with cross-clamping of atherosclerotic vessels.

PMID:
21070122
[PubMed - indexed for MEDLINE]
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