By: Marco C. Stehouwer, Chris Boers, Roel de Vroege, Johannes C. Kelder, Alaaddin Yilmaz, Peter Bruins

The use of minimized extracorporeal circuits (MECC) in cardiac surgery is an important measure to increase the biocompatibility of cardiopulmonary bypass during coronary artery bypass grafting (CABG).
These circuits eliminate volume storage reservoirs and bubble traps to minimize the circuit. However,
the reduction in volume may increase the risk of gaseous microemboli (GME). The MECC system as
used by our group consists of a venous bubble trap, centrifugal pump, and an oxygenator. To further
reduce the risk of introducing GME, an oxygenator with an integrated arterial filter was developed
based on the concept of minimal volume and foreign surface. We studied the air removal characteristics of this oxygenator with and without integrated arterial filter. The quantity and volume of GME were
measured with precision at both the inlet and outlet of the devices.
Our results showed that integration of an arterial filter into this oxygenator increased GME reducing
capacity from 69.2% to 92%. Moreover, we were able to obtain data on the impact of an arterial filter
on the exact size-distribution of GME entering the arterial line.
The present study demonstrates that an MECC system and oxygenator with integrated arterial filter
significantly reduces the volume and size of GME. The use of an integrated arterial filter in an MECC system may protect the patient from the deleterious effects of CPB and may further improve patient safety.

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