title: The endovascular coronary sinus catheter in minimally invasive mitral and tricuspid valve surgery: a case series.
abstract: OBJECTIVE
  To determine the safety and efficacy of a standardized approach to the use of an endovascular coronary sinus (CS) catheter during minimally invasive cardiac surgery.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Patients undergoing mitral and/or tricuspid valve surgery using a minimally invasive cardiac surgery approach.
  
  
  METHODS
  An endovascular CS catheter was placed to enable the administration of retrograde cardioplegia using transesophageal echocardiography (TEE), fluoroscopy, and CS pressure measurements.
  
  
  RESULTS
  Data were collected from 96 patient records. A total of 95 (99.0%) endovascular coronary sinus catheters were positioned. The mean time to insert the catheter into the sinus ostium under TEE guidance was 6.3 ± 8.4 minutes. Confirmation of adequate positioning with fluoroscopy took an average of 9.1 ± 10.6 minutes for a mean total procedure time of 16.1 ± 14.1 minutes. Successful positioning, as defined by the ability to generate a perfusion pressure in the CS greater than 30 mmHg during surgery, was achieved in 87.5% of cases. During positioning, ventricularization of the CS pressure curve was observed in 86.0% of cases. The presence of ventricularization was associated with an increase in positioning success (odds ratio = 15.8; 95% confidence interval, 3.713-67.239). One patient developed extravasation of contrast agent after CS catheter placement, without evidence of CS rupture.
  
  
  CONCLUSIONS
  Endovascular CS catheter insertion can be performed with a high rate of success for positioning and a low complication rate. During positioning, obtaining ventricularization is associated with an increased success rate.
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada. lebon034@hotmail.com
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Lebon
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Antoine G
authors.initials: AG
authors.lastname: Rochon
authors.forename: Eric
authors.initials: E
authors.lastname: Laliberté
authors.forename: Julie
authors.initials: J
authors.lastname: Harvey
authors.forename: Nathalie
authors.initials: N
authors.lastname: Aubé
authors.forename: Mariève
authors.initials: M
authors.lastname: Cossette
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Hugues
authors.initials: H
authors.lastname: Jeanmart
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods; D054326:Coronary Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*