Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia

Orihashi, Kazumasa; Miyashita, Kohei; Tashiro, Mitsuru; Kihara, Kazuki; Kondo, Nobuo; Yamamoto, Masaki; Hirose, Nobuyoshi; Fukutomi, Takashi; Nishimori, Hideaki

doi:10.1016/j.athoracsur.2016.06.022

Cited by 4 publications

(3 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although insertion of a CS cannula can be facilitated and confirmed using fluoroscopic guidance and pressure waveform analysis, perioperative real-time TEE has the benefit of providing continuous visualization of both the CS and CS cannula without the need for contrast or radiation exposure [ 7 ] and can both reduce the risk of CS injury [ 13 ] and detect complications related to cannulation [ 14 , 15 ]. Prior to instrumentation of the CS, imaging allows for the identification of anatomic variants that may preclude the use of retrograde cardioplegia such as a persistent left superior vena cava, Thebesian valve [ 16 , 17 ], atrial septal defect or sinus venosus defect [ 18 ], Chiari network [ 2 ], or anomalous great cardiac venous drainage [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view

et al. 2022

View full text Add to dashboard Cite

Background Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views. Methods After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar’s Exact test. Results Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula. Conclusions Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited.

show abstract

Section: Discussionmentioning

confidence: 99%

Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Coronary sinus injury is a rare but potentially life-threatening complication resulting from the use of a retrograde cardioplegia catheter, with an incidence range reported from 0.053% to 0.6% and with mortality reported as high as 20%. 2,4,6,7 The injury is typically from cannulation or balloon overinflation. Misalignment of the catheter within the course of the coronary sinus can make cannulation difficult and contribute to injury.…”

Section: Introductionmentioning

confidence: 99%

“…In procedures involving a sternotomy, the catheter is inserted via right atriotomy and typically directed by manual palpation, often under transesophageal echocardiography (TEE) guidance. 4 In minimally invasive procedures, insertion of the retrograde cardioplegia catheter can be performed with endovascular techniques, guided by fluoroscopy and TEE. Retrograde cardioplegia provides several benefits in operative efficiency and myocardial protection, including (1) efficient cardioplegia delivery during aortic root procedures without potential injury to the coronary ostia, (2) more effective delivery of cardioplegia in the presence of extensive coronary artery disease, (3) reduced atrial rewarming, and (4) prevention of left ventricular distension in patients with aortic valve insufficiency.…”

Section: Introductionmentioning

confidence: 99%

A Reproducible and Effective Technique for Coronary Sinus Injury Repair

Smith

Spear

Ryan

et al. 2022

Innovations�(Phila)

View full text Add to dashboard Cite

Objective: Coronary sinus injury related to the use of a retrograde cardioplegia catheter is a rare but potentially life-threatening complication with mortality reported as high as 20%. We present a series of iatrogenic coronary sinus injuries as well as an effective method of repair without any ensuing mortality. Methods: There were 3,004 cases that utilized retrograde cardioplegia at our institution from 2007 to 2018. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. A pericardial roof repair was performed in 14 cases in which autologous pericardium was sutured circumferentially to normal epicardium around the injury with purified bovine serum albumin and glutaraldehyde injected into the newly created space as a sealant. Incidence of perioperative morbidity and mortality, operative time, and length of stay were collected. Results: In our series, there were no intraoperative or perioperative mortalities. Procedure types included coronary artery bypass grafting (CABG), valve replacement and repair, or combined CABG and valve procedures. Median (interquartile range) cross-clamp time was 100 (88 to 131) minutes, cardiopulmonary bypass duration was 133 (114 to 176) minutes, and length of stay was 6 (4 to 8) days. None of the patients returned to the operating room for hemorrhage, and there were no complications associated with the repair of a coronary sinus injury when using the pericardial roof technique. Conclusions: Coronary sinus injuries can result in difficult to manage perioperative bleeding and potentially lethal consequences from cardiac manipulation. Our series supports the pericardial roof technique as an effective solution to a challenging intraoperative complication.

show abstract

Cardiopulmonary Bypass

Balaram

Bassin

2023

Cardiac Surgical Complications

View full text Add to dashboard Cite

Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia

Cited by 4 publications

References 7 publications

Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view

Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view

A Reproducible and Effective Technique for Coronary Sinus Injury Repair

Cardiopulmonary Bypass

Contact Info

Product

Resources

About