A Reproducible and Effective Technique for Coronary Sinus Injury Repair

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Thoracic Surgery

Background:

• Coronary sinus injury is a rare but severe complication of retrograde cardioplegia, with reported mortality rates up to 20%.
• Effective management strategies for iatrogenic coronary sinus injuries are crucial to improve patient outcomes.

Purpose of the Study:

• To present a series of iatrogenic coronary sinus injuries.
• To evaluate the efficacy of a pericardial roof repair technique for managing coronary sinus injuries without mortality.

Main Methods:

• A retrospective review of 3,004 cases using retrograde cardioplegia from 2007 to 2018 identified 15 patients with coronary sinus injury (0.49% incidence).
• Fourteen patients underwent a pericardial roof repair using autologous pericardium, bovine serum albumin, and glutaraldehyde sealant.
• Perioperative morbidity, mortality, operative time, and length of stay were analyzed.

Main Results:

• No intraoperative or perioperative mortalities occurred in the 15 patients with coronary sinus injury.
• The pericardial roof repair was successful in all 14 treated cases, with no return to the operating room for hemorrhage or repair-related complications.
• Median cross-clamp time was 100 minutes, cardiopulmonary bypass duration was 133 minutes, and length of stay was 6 days.

Conclusions:

• Coronary sinus injuries pose significant perioperative bleeding risks and potentially lethal consequences.
• The pericardial roof repair technique is an effective and safe method for managing iatrogenic coronary sinus injuries, offering a zero-mortality solution.