Transcript coronary sinus and pa vent complications during minimally invasive

CORONARY SINUS AND PA VENT
COMPLICATIONS DURING
MINIMALLY INVASIVE CARDIAC
SURGERY
Jon Parmet M.D., Nimesh Desai M.D., Ph.D., Homare
Okamura M.D., Robert S. Farivar M.D. Ph.D.
Departments of Cardiothoracic Surgery University of
Pennsylvania
Pennsylvania Hospital
Philadadelphia PA
Introduction
• Queried database for MICS procedures
from(2008-2013)
• Determine patients that received percutaneous
Pulmonary artery venting catheters (PA vent)
and Coronary sinus catheters (CSC).
• Determine incidence of complications with PA
vent and CSC.
Data Base’s
Cannulation strategy for MICS
• Redo upper
– Femoral, full Ao, CSC catheter, endovent
• Mini upper
– Femoral, full ao, endovent
• Right thoracotomy
– Femoral, endo Ao, CSC catheter, endovent
• Mini lower
– Femoral, full Ao, csc catheter
Results
Diagram of MICS Cases
140 MICS
88 mini AVR
24 redo-upper Hemi
52 min MVR
64 upper Hemi
21 lower Hemi
31 right thoracotomy
Results
Complications of PA vent and CSC
• Coronary Sinus (CS) perforation
– 2 redo upper ( 1.4%)
– Limited Pericardial effusion- scarring contained CS
perforation
– Procedure postponed – after 2 weeks procedure done
• Main Pulmonary artery intramural hematoma
–
–
–
–
–
–
2ndary to suction applied to main PA wall during bypass
no drainage from PA vent during CPB
Unsuccessful wean from CPB
ECMO permit wean from CPB
PA patch permit wean from ECMO
Death 4 weeks post-op 2ndary to infection
Conclusions
• CSC and PA vent safe for majority of MICS cases
• CSC placement for Redo MICS have an increased
risk for coronary sinus perforation
– If perforation, postpone case - monitor for 24 hour in
ICU - return in 2 weeks for full sternotomy.
• Pulmonary artery hematoma 2ndary to PA vent
not reported
– If no drainage from PA vent on CPB discontinue
immediately