Factors Predicting Coronary Sinus Rupture following Cannula Insertion for Retrograde Cardioplegia

Abstract

BackgroundCoronary sinus rupture (CSR) is a rare preventable complication of cannula insertion for retrograde cardioplegia. In the hands of an inexperienced surgeon, this complication has the risk of potential mortality and morbidity, and its repair is technically challenging. Techniques for repairing CSR have been reported previously. In this study, we determined predictors of CSR following coronary artery bypass graft (CABG) surgery.MethodsOver a four-year period, we retrospectively analyzed 1500 patients in whom a retrograde coronary sinus catheter was used to administer cardioplegic solution. CSR occurred in 15 patients. (12 women and 3 men). Variables such as age, weight, body mass index, gender, aortic clamp time, pump time, cardiomegaly, ejection fraction, and number of grafts were determined for each patient. Factors correlated with CSR were analyzed using multiple regression analysis, and odd ratios of significant variables were determined.ResultsIn multiple regression analysis, factors such as female gender, age, weight, and body mass index showed a significant correlation with CSR, and their odd ratios were 4.2, 1.0, 0.96, and 2.2, respectively.ConclusionIn all 15 cases, a retrograde cannula with a self-inflatable balloon was used and 12 patients were woman with low body mass index. Forceful insertion due to coronary sinus web, fragility of arteries in thin patients, or a small coronary sinus caused CSR in the hands of an inexperienced surgeon.

Regional Differences in the Diameter of Coronary Sinus among Black Kenyans

“…Knowledge of CS diameters is important to minimize failure rate [5], complications [6] and enhance operative success [7] during these procedures. These diameters show individual, gender and population variations [8,9].…”

Coronary sinus perforation during reducer implantation

“…Most of the reported cases in the scientific literature occurred during retrograde cardioplegia, with none resulted in patients' death . Sabzi et al in a retrospective analysis found female gender and low body mass index as potential predicting factors for CS rupture ; in their population the incidence for CS rupture was 1.02% (15 patients of 1,465).…”

Commentary: Hemostatic patch for coronary sinus rupture: An efficient solution for a complicated problem?

“…Perhaps the best solution is to not use a retrograde cardioplegia line at all, because its use is not without consequence. 5 If a focal coronary sinus injury does occur, a hemostatic patch might be an efficient solution for a complicated problem. The authors provide a creative, off-label solution that worked in 1 patient.…”