Ann Thorac Surg 1995;60:1129
© 1995 The Society of Thoracic Surgeons
How To Do It
Direct Coronary Sinus Cannulation During Cardioplegic Infusion
Joginder N. Bhayana, MD,
Tomas A. Salerno, MD
Division of Cardiothoracic Surgery, The Buffalo General Hospital and State University of New York at Buffalo, Buffalo, New York
Accepted for publication May 23, 1995.
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Abstract
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Retrograde cardioplegia has gained popularity as an improved method of myocardial protection. Cannulation of the coronary sinus, at times, may be difficult or impossible when the transatrial approach is used. We herein report a technique of direct cannulation of the coronary sinus, which appears to be safe and effective.
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Introduction
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Retrograde cardioplegia is now an accepted technique of myocardial protection [1–3]. Cannulation of the coronary sinus is usually via the transatrial approach [4]. When the right side of the heart is opened, such as during a tricuspid valvular operation, the coronary sinus is cannulated under direct vision, and a pursestring suture prevents catheter displacement. We herein describe a technique for direct cannulation of the coronary sinus without opening the right atrium.
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Technique
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After initiation of cardiopulmonary bypass by cannulation of the ascending aorta and insertion of a single double-stage cannula into the right atrium, the heart is arrested with antegrade infusion of blood cardioplegia. When asystole occurs, the inferior border of the right ventricle is lifted anteriorly, exposing the coronary sinus. A pursestring of 5-0 Prolene (Ethicon, Somerville, NJ) suture is placed approximately 2 cm from the origin of the coronary sinus. After appropriate incision, a small coronary sinus catheter (no. 13 Sarns retrograde coronary sinus catheter; Sarns, Ann Arbor, MI) is inserted directly into the coronary sinus and secured in place (Fig 1
), and cardioplegia is administered. At the end of cardioplegic arrest, the catheter is removed and the suture is tied.
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Fig 1. . Pursestring in the proximal part of the coronary sinus and insertion of a small retrograde coronary sinus catheter into the sinus. (IVC = inferior vena cava; LA = left atrium; RA = right atrium; SVC = superior vena cava.)
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Results
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This technique has been used in 20 patients undergoing aortic valve replacement over the last 6 years in whom cannulation of the coronary sinus via the transatrial approach was not possible. There was no complication associated with the procedure.
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Comment
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Cannulation of the coronary sinus may be difficult for different reasons, including small coronary sinus, presence of a valve at the mouth of the coronary sinus, or other anatomic variations. In some cases, it is simply impossible to cannulate the coronary sinus via the transatrial approach. In such cases, we cannulate the coronary sinus via a direct incision and catheter insertion. The technique herein described is simple, safe, and reliable. Further, catheter displacement is eliminated, ensuring delivery of retrograde continuous normothermic blood cardioplegia.
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Footnotes
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Address reprint requests to Dr Bhayana, The Buffalo General Hospital, 100 High St, Buffalo, NY 14203.
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References
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- Bhayana JN, Kalmbach T, McL. Booth FV, Mentzer RM Jr, Schimert G. Combined antegrade/retrograde cardioplegia for myocardial protection: a clinical trial. J Thorac Cardiovasc Surg 1989;98:956–60.[Abstract]
- Menasché P, Piwicna A. Cardioplegia by way of the coronary sinus for valvular and coronary surgery. J Am Coll Cardiol 1991;18:628–36.[Abstract]
- Salerno TA, Houck JP, Barrozo CAM, et al. Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection. Ann Thorac Surg 1991;51:245–7.[Abstract]
- Drinkwater DC, Laks H, Buckberg GD. A new simplified method of optimizing cardioplegic delivery without right heart isolation. J Thorac Cardiovasc Surg 1990;100:56–64.[Abstract]
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Abstract
Introduction
