Reliability of Percutaneous Pulmonary Vent and Coronary Sinus Cardioplegia in the Setting of Minimally Invasive Aortic Valve Replacement: A Single-Center Experience

Abstract

A lthough percutaneous pulmonary vent and coronary sinus (CS) cardioplegia have been identified as a fundamental skill to provide a safe surgical environment for patients undergoing minimally invasive cardiac surgery for aortic valve replacement (MIAVR), data on the feasibility and results of these have not yet been reported. The aim of this retrospective analysis was to evaluate the reliability and efficacy of ProPlege and EndoVent catheters, commonly referred to as “necklines,” for intraoperative CS cardioplegia and pulmonary artery venting in the setting of MIAVR. The study evaluated the records of 51patients who underwent MIAVR either through upper hemisternotomy or right anterior thoracotomy. The ProPlege device was placed into the CS under transesophageal echocardiography and pressure guidance, and the EndoVent device was placed using pressure-curve monitoring by the anesthesiologist prior to the surgical procedure. Minimally invasive cardiac surgery for aortic valve replacement was performed through a J-shaped upper hemisternotomy in 38 patients and a right anterior thoracotomy in 13 patients. Line performance, time needed for placement, rate of successful placement, and major perioperative complications were recorded and reviewed. Necklines were placed successfully in all patients, and the mean time for the placement was 14 ± 9 minutes for ProPlege and 9 ± 4 minutes for EndoVent. A total of 110 doses of retrograde cardioplegiawere delivered through the ProPlege device at a mean flow rate of 173±35mL/min and amean pressure of 41±6mmHg. Venting of the heart by the pulmonary catheter grading was “excellent” in 33 patients, “sufficient” in 12 patients, and “not adequate” in 2 patients. Thesewere surgeon-reported scores based on satisfaction in the degree of freedom from blood in the field. Results showed no deaths or complications, including perioperative myocardial infarction, postoperative re-exploration for bleeding, stroke, kidney failure, or low-output syndrome. In conclusion, ProPlege devices and EndoVent catheters were found to be reliable and ensured effective CS cardioplegia and pulmonary artery venting in the setting of MIAVR. The necklines provided adequate myocardial protection, acceptable grade of venting of the heart, and unobstructed vision and access during MIAVR procedures. Further research is required to demonstrate the advantages of necklines over conventional techniques.