Optimization of CPB Circuits and Techniques Minimize the Total Number of Intraoperative Emboli Delivery in Congenital Heart Surgery Patients

We read with great interest Twedt and his colleagues’ recent article entitled “Most high-intensity transient signals are not associated with specific surgical maneuvers.”¹ The authors documented that “the great majority of HITS detected are not definitively associated with a specific subset of surgical maneuvers. Among the measured maneuvers, removal of the aortic cross-clamp was associated with the greatest occurrence of HITS.”¹

In summary, the generation and delivery of microemboli during CPB procedures are multifactorial and multidisciplinary. Therefore, the solutions to this significant problem should also be multidisciplinary. Optimization of CPB circuitry and techniques are necessary to minimize intraoperative injuries during pediatric cardiac surgery. We congratulate Twedt and colleagues for utilizing the new-generation TCD device for this underserved pediatric cardiac population and using a multidisciplinary team approach to describe the current problem while offering potential solutions. We hope to read future articles from this group, particularly those involved in differentiation of gaseous and particulate emboli during pediatric CPB.