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OBJECTIVE: During minimally invasive cardiac surgery (MICS) the myocardial protection can sometimes represent a challenge, especially when aortic insufficiency is associated. The Proplege Peripheral Retrograde Cardioplegia Device (PPRCD) (Edwards Lifesciences LLC, Irvine, CA USA) has been introduced as a new tool during MICS in order to safely administrate retrograde cardioplegia and to optimize myocardial protection. We present our single center early experience with this device.
METHODS: Since June 2012 we performed retrograde cardioplegia using the PPRCD in 17 patients who underwent minimally invasive cardiac surgery (mitral, tricuspid and aortic) with associated aortic insufficiency. The device was introduced through the dedicated 11F sheath into the right internal jugular vein. Under the only trans-esophageal echocardiographic (TEE) control, the catheter was inserted into the coronary sinus and its position was confirmed by the pressure line. During CPB and aortic cross clamping, the balloon at the top of the catheter was inflated and retrograde cold blood cardioplegia was administered (180-220 ml/min). Color duplex was used to visualize cardioplegia flow into the coronary sinus. After cardioplegia delivery and stable myocardial arrest, the balloon was deflated. Cardioplegia administration was repeated every 30 min. Both visualization and manipulation of the catheter into the right atrium under TEE were performed by the anesthesiologist alone.
RESULTS: In 14 of 17 patients (82%) the coronary sinus canulation was achieved and the cardioplegia delivery performed without any technical complication. The mean time for catheter positioning into the coronary sinus was 24 ± 16 min. We registered no postoperative complications device or myocardial protection related. The 3 cases of technical failure were attributed to small coronary sinus ostium or difficulties in ostium echo-visualization.
CONCLUSIONS: We believe that the PPRCD should be considered as an important tool by minimally invasive heart teams in order to optimize myocardial protection, especially when aortic insufficiency is associated. A learning curve is necessary for a single experienced operator that can perform both TEE visualization and safe catheter manipulation.