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

Hanada S, Sakamoto H, Swerczek M, Ueda K - BMC Anesthesiol (2016)

Bottom Line: 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.The catheter was successfully placed in 74 of those cases.No variables associated with prolongation of APT or CSC placement failure were identified.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.

ABSTRACT

Background: Placement 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.

Methods: We 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.

Results: Percutaneous 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.

Conclusions: The 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.

No MeSH data available.


Related in: MedlinePlus

Confirmation of CSC position by contrast fluoroscopy. The usual catheter advancement is approximately 4 to 5 cm beyond the coronary sinus osmium. The white oval identifies the nominal projection of the coronary sinus ostium
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Fig6: Confirmation of CSC position by contrast fluoroscopy. The usual catheter advancement is approximately 4 to 5 cm beyond the coronary sinus osmium. The white oval identifies the nominal projection of the coronary sinus ostium

Mentions: In order to minimize the risk of catheter dislodgement, we advanced the catheter under live fluoroscopy guidance until the tip lay between 2/3 and 3/4 of the distance between the coronary sinus ostium and the left border of the heart. The usual advancement was approximately 4 to 5 cm beyond the coronary sinus osmium (Fig. 6). In addition, at our institution the balloon of the catheter tip was inflated during the entire surgery until the catheter was no longer needed, although there might be a potential risk of coronary sinus damage or thrombus formation with this strategy. Lastly, the catheter stylet was kept inside the cardioplegia lumen until the administration of cardioplegia was required. All of these three methods used at our institution could have reduced the risk of catheter dislodgment.Fig. 6


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

Hanada S, Sakamoto H, Swerczek M, Ueda K - BMC Anesthesiol (2016)

Confirmation of CSC position by contrast fluoroscopy. The usual catheter advancement is approximately 4 to 5 cm beyond the coronary sinus osmium. The white oval identifies the nominal projection of the coronary sinus ostium
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940684&req=5

Fig6: Confirmation of CSC position by contrast fluoroscopy. The usual catheter advancement is approximately 4 to 5 cm beyond the coronary sinus osmium. The white oval identifies the nominal projection of the coronary sinus ostium
Mentions: In order to minimize the risk of catheter dislodgement, we advanced the catheter under live fluoroscopy guidance until the tip lay between 2/3 and 3/4 of the distance between the coronary sinus ostium and the left border of the heart. The usual advancement was approximately 4 to 5 cm beyond the coronary sinus osmium (Fig. 6). In addition, at our institution the balloon of the catheter tip was inflated during the entire surgery until the catheter was no longer needed, although there might be a potential risk of coronary sinus damage or thrombus formation with this strategy. Lastly, the catheter stylet was kept inside the cardioplegia lumen until the administration of cardioplegia was required. All of these three methods used at our institution could have reduced the risk of catheter dislodgment.Fig. 6

Bottom Line: 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.The catheter was successfully placed in 74 of those cases.No variables associated with prolongation of APT or CSC placement failure were identified.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.

ABSTRACT

Background: Placement 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.

Methods: We 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.

Results: Percutaneous 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.

Conclusions: The 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.

No MeSH data available.


Related in: MedlinePlus