Initial experience with percutaneous coronary sinus catheter placement in minimally invasive cardiac surgery in an academic center

Abstract

BackgroundPlacement of a percutaneous coronary sinus catheter (CSC) by an anesthesiologist for retrograde cardioplegia in minimally invasive cardiac surgery is relatively safe in experienced hands. However, the popularity of its placement remains limited to a small number of centers due to its perceived complexity and potential complications.MethodsWe retrospectively reviewed all cardiac cases performed by one surgeon between December 2009 and April 2012. The reviewed cases were divided into two groups: cardiac cases with percutaneous CSC placement (CSC group) and cardiac cases without placement (control group). Anesthesia preparation time (APT) was then compared between the CSC group and control group. In the CSC group, cases were further divided into two groups. One group contained cases with an APT of less than 90 min (success group) and the other contained cases with an APT greater than or equal to 90 min or cases with CSC placement failure (delay/failure group). Patients’ characteristics, type of surgery, and transesophageal echocardiography (TEE) findings were compared between the two groups (success group vs. delay/failure group) to identify variables associated with prolongation of the APT or CSC placement failure.ResultsPercutaneous CSC placement was required in 83 cases (CSC group). The catheter was successfully placed in 74 of those cases. We experienced one complication, coronary sinus injury after multiple attempts at placing the catheter. The mean APT was 102 ± 31 min in the CSC group (n = 81) and 42 ± 15 min in the control group (n = 285). We could not identify any variables associated with prolongation of the APT or catheter placement failure.ConclusionsThe success rate of the placement was 89.1 % in our academic center. On average, placing the CSC added approximately one additional hour to the APT. This time is not an accurate representation of true catheter placement time, as it included time for preparation of the CSC, TEE, and fluoroscopy. We experienced one documented complication (coronary sinus injury), which was immediately diagnosed by TEE and fluoroscopy in the operating room. No variables associated with prolongation of APT or CSC placement failure were identified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0203-4) contains supplementary material, which is available to authorized users.

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

“…In patients with aortic insufficiency, retrograde cardioplegia is important to provide adequate myocardial protection without causing LV distention [12]. Cannulation of the CS for retrograde cardioplegia delivery is also critical in minimally invasive cardiac surgery, where the CS cannula is placed percutaneously by the anesthesiologist using TEE guidance [1][2][3][4][5][6][7].…”

“…Cannulation of the coronary sinus (CS) is performed to administer retrograde cardioplegia for cardiac surgeries. Whether performed by the surgeon via median sternotomy or percutaneously by an anesthesiologist, transesophageal echocardiographic (TEE) imaging plays an important role in assessing CS anatomy and then guiding and confirming placement of the CS cardioplegia cannula [1][2][3][4][5][6][7].…”

Robotic Cardiac Surgery Part I: Anesthetic Considerations in Totally Endoscopic Robotic Cardiac Surgery (TERCS)

“…10 An institutional review of the initial experience with percutaneous CS catheter placement by Hanada et al describes an additional 1 hour added to anesthesia preparation time, an 88.9% success rate, and a 0.01% injury rate resulting in the delay of surgery. 11 There were no identifiable variables to predict prolonged placement time or failure.…”

Commentary: When the heart team may save the patient’s heart!

“…Apart from the attractive approach described by Mehta and colleagues, 3 which is also impeccable, the strength of this study is represented by the perfect synergy of each specialist within the heart team. Refined techniques such as percutaneous endoaortic balloon occlusion, 4,5 percutaneous coronary sinus catheter placement, [6][7][8] and percutaneous pulmonary venting 7,9 are safe procedures if performed by experienced anesthesiologists. Moreover, the hybrid operating room allows the surgeons, anesthesiologists, perfusionists, and nursing staff to perform these high-risk operations safely.…”