Myocardial Protection in Minimally Invasive Mitral Valve Surgery: Retrograde Cardioplegia Alone Using Endovascular Coronary Sinus Catheter Compared With Combined Antegrade and Retrograde Cardioplegia

Myocardial Protection in Minimally Invasive Cardiac Surgery: Evolved Techniques for the New Era of Cardiac Surgery

“…12 The strategy of retrograde cardioplegia delivery alone was studied by Lebon et al in patients undergoing minimally invasive mitral valve surgery. 13 Endovascular coronary sinus catheters were placed through right internal jugular vein access and guided fluoroscopically into position. Blood cardioplegia was delivered, and after aortic cross-clamping, coronary sinus perfusion pressures were monitored to ensure values of 30 mm Hg or more were maintained with delivery rates at 150 mL/min or less.…”

“…The authors emphasize the importance of ensuring correct positioning of the coronary sinus catheter, along with monitoring for adequate perfusion pressure and flow rates. 13 Surgeons should anticipate that not all patients may obtain adequate myocardial protection from retrograde-only cardioplegia delivery and to be prepared to supplement with antegrade delivery if needed.…”

Mitigating cardiac dysfunction by TOE-guided cardioplegia and mitral valve repair

“…We therefore have reservations about relying solely on retrograde cardioplegia which has become widely used in minimally invasive surgery. 19 TOE-guided de-airing before and immediately after weaning from bypass also has implications for postoperative cardiac function. Complete washing out of subtle intramyocardial echo contrast, usually in the regions supplied by the right coronary artery, should be confirmed on TOE before weaning from bypass.…”

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.…”