“De-airing” in open heart surgery: report from the CVSAP nation-wide survey and literature review

  • Kazumasa OrihashiEmail author
  • Toshihiko Ueda
Review Article


Since the beginning of cardiac surgery, retained intracardiac air has been an important problem. While transesophageal echocardiography enabled to visualize the air and de-airing procedures have been routinely done, they appear to vary much among institutions not necessarily based on firm scientific evidence. Thus, “de-airing” was chosen as the theme of 2016 CVSAP (cardiovascular surgery and anesthesia and perfusion) symposium and a nation-wide questionnaire survey was carried out prior to it. This paper reports on its results and illustrate “the best of de-airing” based on literature review. The collection rate of the questionnaire survey was 77.9% (278/357) and 83.3% (85/102) from the major institutions of surgeons and anesthesiologists, respectively. More than 90% of both consider de-airing as important, since adverse events of air embolism were actually encountered including critical ones. Most routinely performed de-airing procedures are posture change, lung inflation and aspiration through the vent cannulae. Direct aspiration is performed in one-third of institutions. Carbon dioxide insufflation is performed in 82.5% of institutions (mostly 2–3 L/min). However, not a few surgeons are skeptical for its significance. While many surgeons are grateful for collaboration by anesthesiologists, some expect more information sharing between them. They also expect that clinical engineers understand “de-airing” better and operate the extracorporeal circulation system appropriately to avoid an occurrence of undesirable event. Some surgeons anticipated a convenient device for de-airing. Furthermore, some questions to be solved in the future were raised, including how meticulously the bubbles should be removed or how efficient carbon dioxide insufflation is.


Cardiac surgery Retained air Air embolism 



The authors acknowledge Dr. Yasuhiro Koide, the President of the 21st Annual Meeting of JSCVA, and Dr. Kazuhiro Hashimoto, the President of the 46th Annual Meeting of JSCVS, where the CVSAP symposia on this topic were projected, the members of the board of governors of both societies and office personnel for carrying our the survey prior to the symposia, and the surgeons and anesthesiologists who replied to the questionnaires with detailed comments and questions.

Compliance with ethical standard

Conflict of interest

The authors have no conflict of interest.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Second Department of SurgeryKochi Medical SchoolNankokuJapan
  2. 2.Division of Cardiovascular SurgeryTokai University Hachioji HospitalHachiojiJapan

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