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Does the use of carbon dioxide field flooding during heart valve surgery prevent postoperative cerebrovascular complications?

^a Department of Surgery, Vaasa Central Hospital, Hietalahdenkatu 2-4, 65130, Vaasa, Finland
^b Department of Surgery, Oulu University Hospital, Oulu, Finland

*Corresponding author. Tel.: +358 443346119; fax: +358 6323152.

E-mail address: salvatoregiordano{at}yahoo.it (S. Giordano).

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any benefit with the use of carbon dioxide (CO₂) field flooding techniques in heart valve surgery, in order to reduce postoperative neurological complications. Altogether 202 articles were found using the reported search, and six of them were used to answer the clinical question. All but one trial, were prospective, randomised. Four studies reported a significantly lower intracardiac bubble count in the CO₂ group. A significant reduction of p300 peak latencies in the CO₂ group was observed in one study. Otherwise, neurocognitive test batteries did not reveal any advantages of CO₂ field flooding in two studies. Three studies reported on postoperative cerebrovascular complications and the overall rate of stroke, transient ischemic attack (TIA) or prolonged reversible ischemic neurological deficit was 1.2% in the CO₂ group and 2.5% in the control group (P=ns). Although the use of CO₂ field flooding has been observed to be associated with a significantly lower count of intracardiac air bubbles, and improved survival in two small studies, so far there is no evidence of a sustained reduction of cerebrovascular complications with the use of this method.

Key Words: Evidence-based medicine; Heart valve surgery; Carbon dioxide field flooding; Air embolisation; Stroke