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Hydrodissection of the Retro-Sternal Space to Protect the Pericardium During Sternal Cryoablation
Pierre-Alexis Autrusseau1, Julien Garnon2, Pierre Auloge2
1Service D'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France. pierrealexis.autrusseau@chru-strasbourg.fr.
Insights
Retro-sternal space hydrodissection safely displaces the pericardium, protecting it during sternal cryoablation. This technique achieved 100% technical success, demonstrating its feasibility for preventing cardiac ice ball formation.
Area of Science:
- Interventional Cardiology
- Medical Imaging
- Surgical Techniques
Background:
- Sternal cryoablation (CA) requires precise temperature control to prevent cardiac injury.
- The retro-sternal space anatomy presents challenges for thermoprotection during sternal procedures.
- Minimizing collateral thermal damage to the pericardium is crucial for patient safety.
Purpose of the Study:
- To detail the retro-sternal space hydrodissection technique.
- To assess the efficacy of hydrodissection in displacing the pericardium for thermoprotection.
- To evaluate the safety and success of hydrodissection prior to sternal cryoablation.
Main Methods:
- Retrospective analysis of 5 patients undergoing percutaneous image-guided sternal cryoablation.
- Hydrodissection of the retro-sternal space using iodinated contrast via 1-2 needles.
- Assessment of needle approach, injectate volume, procedure time, and distances between lesion/ice-ball and pericardium.
Main Results:
- 100% technical success in completing cryoablation without pericardial ice ball contact.
- Mean distance to pericardium increased from 5.8 mm to 22.2 mm post-hydrodissection.
- No immediate, short-, or medium-term complications were observed.
Conclusions:
- Retro-sternal space hydrodissection is a feasible and safe technique.
- This method effectively protects the pericardium from thermal injury during sternal cryoablation.
- Hydrodissection enhances safety margins for sternal cryoablation procedures.
Purpose:
To report the retro-sternal space hydrodissection technique used to displace the heart and the pericardium posteriorly for thermoprotection ahead of sternal cryoablation (CA).
Methods And Materials:
Between May 2015 and March 2020, hydrodissection of the retro-sternal space was performed in 5 consecutive patients (5 female; mean age 55.2 ± 9.3 years, range 41-65) who underwent percutaneous image-guided cryoablation of the sternum. The number of needles required, the implemented approach, volume of injectate to achieve hydrodissection, hydrodissection procedure time, distance between the lesion and the pericardium before and after hydrodissection, distance between the ice-ball and the pericardium, technical success and complications were retrospectively assessed.
Results:
Technical success, defined as the completion of a full dual freeze protocol without contact between the ice-ball and the pericardium, was achieved in all cases (5/5, 100%). One to two needles were used to perform hydrodissection via a perpendicular (3/5) or an anterior oblique approach (2/5) and a mean hydrodissection procedure time of 10.4 ± 2.6 min (range 8-14). Minimum distance between the lesion and the pericardium increased from mean 5.8 ± 3.8 mm (range 0-10) before hydrodissection to a mean 22.2 ± 5.8 mm (range 18-32) after, with a mean distance between the final ice-ball and the pericardium of 11.6 ± 8.7 mm (range 7-27). A mean of 198 ± 79.8 mL (range 90-290) of iodinated contrast was injected. There were no immediate, short- or medium-term complication noted.
Conclusion:
Hydrodissection of the retro-sternal space is a feasible technique for sternal cryoablation in order to protect the pericardium from freezing for sternal cryoablation.
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