Objective: Coronary sinus injury related to the use of a retrograde
cardioplegia catheter is a rare but potentially life-threatening complication 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: There were 3,004 cases that utilized retrograde
cardioplegia at our institution from 2007 to 2018. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. 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. Incidence of perioperative morbidity and mortality,
operative time, and
length of stay were collected. Results: In our series, there were no intraoperative or perioperative mortalities. Procedure types included
coronary artery bypass grafting (CABG), valve replacement and repair, or combined CABG and valve procedures. Median (interquartile range) cross-clamp time was 100 (88 to 131) minutes,
cardiopulmonary bypass duration was 133 (114 to 176) minutes, and
length of stay was 6 (4 to 8) days. None of the patients returned to the operating room for
hemorrhage, and there were no complications associated with the repair of a coronary sinus injury when using the pericardial roof technique. 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.