title: Reliability of Percutaneous Pulmonary Vent and Coronary Sinus Cardioplegia in the Setting of Minimally Invasive Aortic Valve Replacement: A Single-Center Experience.
abstract: OBJECTIVE
  Evaluating the efficacy of 2 new percutaneous devices specifically designed to be placed through the right internal jugular vein, therefore named "necklines," for achieving retrograde cardioplegia and pulmonary venting in the setting of minimally invasive aortic valve replacement (MIAVR).
  
  
  METHODS
  Case series.
  
  
  METHODS
  University-affiliated private hospital.
  
  
  METHODS
  Patients undergoing MIAVR.
  
  
  METHODS
  Necklines were placed by the anesthesiologist using transesophageal electrocardiography, with pressure guidance before the surgical procedure was initiated.
  
  
  RESULTS
  The records of 51 consecutive patients who underwent MIAVR with necklines placement were reviewed retrospectively. The access for MIAVR was through either a J-hemisternotomy or a right anterior thoracotomy. The efficacy of the 2 catheters, successful placement rate, time needed to deploy catheters, and perioperative complications were recorded. Necklines were placed successfully in all patients in 23±13 minutes. A total of 110 doses of retrograde cardioplegia were delivered at a mean flow rate of 173±35 mL/min and a mean pressure of 41±6 mmHg. The pulmonary catheter ensured venting of the heart that was graded by surgeons as "excellent" in 33 patients, "sufficient" in 12 patients, and "not adequate" in 2 patients. There were no major adverse events or deaths.
  
  
  CONCLUSIONS
  Necklines ensure effective retrograde cardioplegia and venting of the heart, provide optimal surgical vision and access during MIAVR, and allow surgeons to operate in an unobstructed surgical field. Nevertheless, additional studies are required to determine whether the use of necklines is associated with better outcomes than those with conventional methods.
authors.affiliation: Department of Cardiac Anesthesia, Santa Maria Hospital-GVM Care & Research, Bari, Italy. Electronic address: dino.labriola@gmail.com.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Labriola
authors.affiliation: Division of Cardiac Surgery, University of Bari, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.affiliation: Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Labriola
authors.affiliation: Department of Cardiac Anesthesia, Santa Maria Hospital-GVM Care & Research, Bari, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Dambruoso
authors.affiliation: Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.affiliation: Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000379:methods / Q000592:standards; D054326:Coronary Sinus / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods / Q000592:standards*; D006350:Heart Valve Prosthesis / Q000592:standards*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000592:standards*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: aortic valve replacement; echocardiography; minimally invasive cardiac surgery; percutaneous devices, “necklines,” internal jugular catheters