Left ventricular pacing lead insertion via the coronary sinus cardioplegia cannula: A novel method for temporary biventricular pacing during reoperative cardiac surgery

Wang, Daniel; Gerrah, Rabin; Rusanov, Alexander; Yalamanchi, Vinay; Cabreriza, Santos E.; Spotnitz, Henry M.

doi:10.1016/j.jamcollsurg.2010.06.082

Cited by 1 publication

(3 citation statements)

References 26 publications

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“…25 Anesthesia was maintained with isoflurane (1.75%Y2.5%) in oxygen. With institutional permission, high-resolution computerized axial tomography (CAT) scans were obtained with contrast enhancement.…”

Section: Animal Surgerymentioning

confidence: 99%

“…Two Yorkshire pigs (28Y33 kg) were anesthetized intramuscularly with atropine (0.02 mg/kg), ketamine (20 mg/kg), and xylazine (0.5 mg/kg), followed by oral endotracheal intubation and mechanical ventilation (SC), as previously described. 25 Anesthesia was maintained with isoflurane (1.75%Y2.5%) in oxygen. With institutional permission, high-resolution computerized axial tomography (CAT) scans were obtained with contrast enhancement.…”

Section: Animal Surgerymentioning

confidence: 99%

“…23 Right parasternal mediastinotomy has also been used for coronary artery bypass surgery in pigs. 24 We recently described LV lead insertion via a CS cardioplegia cannula 25 and demonstrated echocardiography-guided CS lead insertion. 26 The present study was undertaken to assess the feasibility of CS lead insertion via RPSM.…”

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confidence: 99%

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Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

Spotnitz

Yeager

Cabreriza

et al. 2015

Innovations�(Phila)

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Objective Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. Methods Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. Results Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. Conclusions Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.

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Section: Animal Surgerymentioning

confidence: 99%

Section: Animal Surgerymentioning

confidence: 99%