Percutaneous Coronary Sinus Catheter Placement and Management With Transesophageal Echocardiography for Robotic...

Placement of a percutaneous coronary sinus catheter (CSC) for retrograde cardioplegia delivery in minimally invasive cardiac surgery has been implemented at various centers. While several techniques have been described for catheter placement, we present our experience utilizing transesophageal echocardiography (TEE) alone for guiding the successful placement and management of percutaneous CSC during robotic mitral valve repair (MVr).

We retrospectively studied all adult patients who underwent planned robotic MVr by a single surgeon at our institution from August 2013 to December 2021. Confirmation of successful CSC placement was made by review of electronic medical records and TEE data.

Out of 144 patients in the study cohort, 135 (94%) patients had successful CSC placement. The median time from anesthesia start in the operating room to surgical incision was 93 min (interquartile range 82-103 min). Of the 135 patients with successful CSC placement, 122 patients (90%) had maintenance of cardiac arrest during cardiopulmonary bypass with retrograde cardioplegia only. Two patients (1.4%) had complications; one had an injury of the coronary sinus (unrelated to CSC placement) requiring sternotomy, and one had an episode of ventricular tachycardia requiring defibrillation.

In our experience, TEE guidance offers an effective approach for percutaneous CSC placement without requiring fluoroscopic guidance. It allows the safe conduct of surgery with multidose administration of retrograde cardioplegia. The alternative to placing a percutaneous CSC is administration of antegrade cardioplegia only, which may not be feasible in all patients, and if feasible, may have limitations in robotic MVr.