PercutaneousBicaval Balloon Occlusion In Minimally Invasive Right-sided Heart Surgery: Our Initial Experience

Beatrice Bacchi¹, Yasuhiko Kawaguchi¹, Ahmad Alli², Kendra Derry², Gianluigi Bisleri¹

1Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

2Department of Anesthesiology & Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada

 

Objectives

Right-sided heart surgeries—such as tricuspid valve repair or replacement, atrial septal defect (ASD) repair, and correction of partial anomalous pulmonary venous return (PAPVR)—pose technical challenges due to the need for manipulation of the superior and inferior vena cava (SVC and IVC), especially in redo operations complicated by pericardial adhesions. To streamline the approach to bicaval occlusion and minimize surgical dissection, we adopted a percutaneous technique utilizing CODA balloons (Cook Incorporated, Bloomington, IN).

 

Methods 

Cardiopulmonary bypass is established via femoral artery and venous cannulation through femoral and right jugular veins. Initially, we used 3/8-3/8-3/8 Y-connector for CODA balloon insertion into both venous lines. This approach was later refined to directly insert a CODA balloon into 12 Fr sheaths in the right jugular vein (via a secondary access) and contralateral femoral vein. Balloon placement in the SVC and IVC was guided by transesophageal echocardiography and inflated prior to right atriotomy to ensure complete occlusion. This technique avoided the surgical dissection of the IVC and SVC.

Results 

Table 

 

Conclusions

Our  preliminary experience indicates that percutaneous bicaval balloon occlusion with CODA balloons is a feasible and safe alternative to conventional techniques in minimally invasive right-sided heart surgery. This methodappears especially beneficial in redo procedures, where adhesions pose significantchallenges to standard surgical dissection. Further clinical application and evaluation are needed to validate the broader applicability and long-termoutcomes of this technique.