PO-02-024 ANCHOR BALLOON TECHNIQUE AS A RESCUE STRATEGY FOR CHALLENGING CORONARY SINUS CANNULATION: A CASE SERIES

Abstract

Cardiovascular resynchronization therapy (CRT) improves outcomes in patients with chronic systolic heart failure and interventricular dyssynchrony. However difficult coronary sinus (CS) access due to tortuosity, stenosis or steep angulation can pose challenges to successful left ventricular (LV) lead implantation. Many such cases require surgical epicardial LV lead placement which is more invasive and associated with higher incidence of complications. Despite the use of interventional tools and techniques, such as use of delivery sheaths of varied sizes, Amplatz support wire, vein selectors and snaring, some cases require more advanced techniques such as anchor balloon as a rescue strategy to ensure successful LV lead placement. We describe a case series of 8 patients where anchor balloon technique was used to cannulate the CS due to inability to cannulate the CS despite using interventional techniques From 2017 to 2020, 8 patients were identified who required the anchor balloon technique for CS cannulation. Clinical information, imaging methods, LV lead implantation techniques, and complications were obtained by retrospective chart review. Stepwise description of using anchor balloon technique for CS cannulation is described in figure 1. The basic principle is to change the angle of approach and create a more supportive rail using compliant coronary balloons over which the sheath is advanced. Coronary balloons offer several advantages, they have a low profile, can track over wire, have a hydrophilic coating and can advance easily into CS. In our cohort of patients, anchor balloon technique was used to successfully cannulate the CS in all 8 patients where the other techniques had failed. In the group, 3 were denovo implants, 3 were upgrades to a prior implant and 2 were redo procedures where other operators had tried to implant the CS lead without success. 2 patients had prior history of open-heart surgery. The details of the patient population in each group are delineated in Table 1. Potential complications from using anchor balloons include vein rupture and laceration leading to pericardial effusion, but these were not seen in our study despite most patients with no prior history of open-heart surgery. Anchor balloon technique when added to the basic interventional CRT tools contributes to successful LV lead implantation in patients with challenging CS anatomy without any significant additional risk.Tabled 1Baseline CharacteristicsPatient IDAge (years)SexPrior open heart surgeryType of implant177MYesRedo271MYesUpgrade346FNoUpgrade471FNoDenovo561MNoDenovo653FNoDenovo757MNoUpgrade857FNoRedo Open table in a new tab