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Factors predicting coronary sinus rupture following cannula insertion for retrograde cardioplegia
Feridoun Sabzi1, Abdolhamid Zokaei
1Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Insights
Female gender, older age, and lower body mass index are significant predictors of coronary sinus rupture (CSR) during coronary artery bypass graft (CABG) surgery. Understanding these factors can help prevent this rare complication.
Area of Science:
- Cardiovascular Surgery
- Surgical Complications
- Cardiac Anesthesia
Background:
- Coronary sinus rupture (CSR) is a rare but serious complication during retrograde cardioplegia delivery.
- It poses risks of mortality and morbidity, particularly with inexperienced surgeons.
- Previous repair techniques exist, but predictor identification is crucial for prevention.
Purpose of the Study:
- To identify predictors of coronary sinus rupture (CSR) following coronary artery bypass graft (CABG) surgery.
- To analyze factors associated with CSR in patients undergoing CABG.
- To inform preventative strategies for CSR during cardiac procedures.
Main Methods:
- Retrospective analysis of 1500 patients undergoing CABG with retrograde coronary sinus catheterization over four years.
- CSR occurred in 15 patients; demographic and surgical variables were collected.
- Multiple regression analysis was used to determine significant predictors and their odds ratios.
Main Results:
- Female gender (OR 4.2), age (OR 1.0), and body mass index (OR 2.2) were significantly correlated with CSR.
- Weight also showed a significant correlation (OR 0.96).
- These factors indicate increased risk in specific patient populations.
Conclusions:
- CSR was observed in 12 women with low body mass index, often using cannulas with self-inflatable balloons.
- Potential causes include forceful insertion, arterial fragility in thin patients, or small coronary sinus size.
- Inexperienced surgeons face challenges, highlighting the need for careful technique and awareness of risk factors.
Background:
Coronary sinus rupture (CSR) is a rare preventable complication of cannula insertion for retrograde cardioplegia. In the hands of an inexperienced surgeon, this complication has the risk of potential mortality and morbidity, and its repair is technically challenging. Techniques for repairing CSR have been reported previously. In this study, we determined predictors of CSR following coronary artery bypass graft (CABG) surgery.
Methods:
Over a four-year period, we retrospectively analyzed 1500 patients in whom a retrograde coronary sinus catheter was used to administer cardioplegic solution. CSR occurred in 15 patients. (12 women and 3 men). Variables such as age, weight, body mass index, gender, aortic clamp time, pump time, cardiomegaly, ejection fraction, and number of grafts were determined for each patient. Factors correlated with CSR were analyzed using multiple regression analysis, and odd ratios of significant variables were determined.
Results:
In multiple regression analysis, factors such as female gender, age, weight, and body mass index showed a significant correlation with CSR, and their odd ratios were 4.2, 1.0, 0.96, and 2.2, respectively.
Conclusion:
In all 15 cases, a retrograde cannula with a self-inflatable balloon was used and 12 patients were woman with low body mass index. Forceful insertion due to coronary sinus web, fragility of arteries in thin patients, or a small coronary sinus caused CSR in the hands of an inexperienced surgeon.
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