Usually I perform the proxymal anastomosis in case of ascending aorta replacement as a first step. After completing the suture of proxymal anastomosis I connect a 20 fr Foley catheter with the line for cardioplegia and I put the catherer into the vascular prosthesis. I fill the foley with 20 cc saline solution reaching a complete occlusion of the vascular prosthesis. In this way, the cardioplegia may be instilled at high pressure and this allows to control bleeding from the proxymal anastomosis and the competence of the aortic valve. This is of great interest in case of aortic valve sparing operations or in case of aortic dissection.
In the old days the French used retrograde cardioplegia with a foley catheter, putting it into the coronary sinus.
A Marty MD, retired CV surgeon.
Thank you very much for your answer. Can you explain: the foley was inserted into the coronary sinus after opening the right atrium? Did you use this method only in case of mitro-tricuspid surgery? Did you fill the balloon at the tip of the catheter? What about risk of injuries?
As you now, the devices nowadays avalable for retrograde cardioplegia administration does not require a right atrium incision.
Did you never use the foley in case of ascending aorta replacement?
Thank you very much again.
Best regards
Personally, I just place the cardioplegia line, without any sort of cannula or catheter, into the graft and occlude it with a heavy clamp; the distal part of the graft is usually trimmed down anyway. El Khoury et al describes a similar technique for testing valve competency, but the just inject saline from a large syringe into the graft, to check for leak or regurgitation. Anecdotally, I have used the Foley catheter as you described in descending aortic repair with an open proximal anastomosis. Moving away from deep to moderate hypothermia, cardioplegia may be of importance if arch reconstruction is time consuming. In such cases, I have inserted the Foley catheter retrogradely, from the distal arch, into the ascending aorta (which is sometimes actually a graft, after previous proximal aortic repair), and administered cardioplegia this way.
/Christian Olsson, Stockholm
Hi Fabrizio. In some cases I did exactly the same you do. I agree with you it's a very good strategy to check the anastomosis and aortic valve competence. In a couple of patients, insted of a Foley Catheter I used a small cannula (for example an atrial vent cannula) inserted in the distal end of the prosthesis and then I shrinked the prosthesis around the cannula with a silk string tied on the prosthesis itself.
Yes you can and I usually test for leaks with this method.
As far as using retrograde by snaring SVC/IVC and clamoing the PA this is the Fabiani Carpentier method and I used to use it years back when I did not have retrograde cardioplegia cannulae.
Thank you very much to everyone for your answers.
Hi luca, I'm happy you also use this technique for cardioplegia!
For Prasanna: I have already published few years ago a technique for the internal snaring of the caval veins by foley catheters in case of redo tricuspidal surgery through right thoracothomy.
Best regards
Today with vacuum assisted venous drainage I ahrdly do any snaring even with an open RA though I ahve used Foleys catheters in the cava for "internal snaring" once in a while.
Thank you very much prasanna.
I agree with you about the vacuum drainage. However, in case of problems, the foley may be a solution.
Thank you very much again.
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