Ersin Doganozü
Turkey, TurkeyTitle: A solution trick: implantation of coronary sinus lead without delivery system, a case series study
Abstract
Background: Cardiac resynchronization
therapy(CRT) is one of the most challanging
prosedure of invasive cardiology. Variations of coronary sinus anatomy and
complexity of the procedure may result unsuccessful implantation or may needed
surgical implantation of coronary sinus lead.
Methods: This
is a retrospective observational case study. The patients were enrolled from
the CRT patients who was implanted LV lead without delivery sheath of
cardiology department between July 2020 and March 2021. Patient information was
obtained by retrospective file scanning.
Description of tips of the trick: Multipurpose (MP) or any diagnostic
catheter is push forward to the right atrium via a tearable safe sheath.
Coronary sinus (CS) ostium is cannulated by the catheter. CS angiography is
performed. Stiff wire (ASAHI Grand Slam, 0.014 inch, 180 cm) is directly
advanced into the target vessel or a soft wire is used for selective cannulation
of targeted tributaries by the catheter and soft wire is exchanged with the
stiff one. The catheter is extracted over stiff guide wire. LV lead is advanced
over stiff guidewire to CS. LV lead is advanced into the target cardiac vein
and stiff wire is extracted.
Results: All patients were male, one of them is 80
years old and the others 50-70 ages. Four patients were suffering from ischemic
cardiomyopathy and one from non-ischemic cardiomyopathy. Four patients were
inpatients, one patient was outpatient. Procedure was performed from right
pectoral area in three patients. In three of the five patients, conservative
technique was planned, and we were unable to cannulate CS or to go a very low
posterior cardiac vein with delivery sheath. We used descripted trick to
cannulate CS or targeted vein as a problem solver. One week and 1-month follow-ups of the
patients was uneventful.
Conclusions: Grand
Slam wire provide back up to CS lead without delivery system and it can help to
implant LV lead. We need more case series and randomized studies to understand
safety and efficacy of the
Biography
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