Cannulae and cell saver design: do they make a difference?

In the evolution of cardiopulmonary bypass (CPB), it is becoming increasing obvious that minimizing microembolization is critical in protecting the brain. Every component of the CPB circuit and ancillary apparatus must be evaluated and, if necessary, re-engineered with the reduction of microemboli a major focus. Cardiotomy suction has been identified as a major source of lipid microemboli. However, is the alternative blood treatment apparatus, the cell saver, capable of reducing the lipid embolic load and are all cell savers equally efficient? In the event that microemboli do make it to the aorta, is it possible to divert them away from the brain to more robust vascular beds through clever design of the aortic cannula? Is the venous cannula a source of microgaseous emboli? The answer is yes to both questions. Emboli can be directed away from the brain by the positioning and design of the aortic cannula and the venous cannulae may be a source of gaseous microemboli delivered to the oxygenator by the venous line but careful practice will prevent this type of embolic formation.