Eastern Cardiothoracic Surgical Society

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A reproducible and effective technique for coronary sinus injury repair
Shane P. Smith, Glenn R. Barnhart, Roland A. Hernandez, Patrick J. Ryan, Samuel J. Youssef, David M. Stout, Eric J. Lehr.
Swedish Medical Center, Seattle, WA, USA.

OBJECTIVE:
Coronary sinus injury is a rare and potentially life-threatening complication of cardiac surgery resulting from the use of a retrograde cardioplegia catheter, with mortality reported as high as 20%. We present a series of iatrogenic coronary sinus injuries as well as an effective method of repair without any ensuing mortality. METHODS:
We retrospectively reviewed 3,004 cases at our institution from 2007 to 2018 that used retrograde cardioplegia. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. Types of coronary sinus injuries include inferior wall hematoma, punctate perforation, and extensive laceration. A pericardial roof repair was performed in 14 cases in which autologous pericardium was sutured circumferentially to normal epicardium around the injury with purified bovine serum albumin and glutaraldehyde injected into the newly created space as a sealant. A primary repair was performed in addition to the pericardial roof when feasible. RESULTS:
In our series, there were no intraoperative or perioperative mortalities. None of the patients returned to the operating room for hemorrhage, and there were no further complications associated with our repair. Procedures included coronary artery bypass, valve replacement and repair, or combination. Median (IQR) cross clamp time was 100 minutes (88, 131), cardiopulmonary bypass duration was 133 minutes (114, 176), length of stay was 6 days (4, 8). CONCLUSIONS:
Coronary sinus injuries can result in difficult to manage perioperative bleeding and potentially lethal consequences from cardiac manipulation. Our series supports the pericardial roof technique as an effective solution to a challenging intraoperative complication.


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