Internal snaring of the caval veins by Foley catheters in case of reoperation via right thoracotomy

Abstract

Use of the Foley catheter has been described in cardiac surgery over a wide range of applications. In recent years, the interest in minimally-invasive surgery has increased, providing several advantages in terms of mortality and morbidity. Unfortunately, challenging situations, such as re-do surgery may be encountered, and innovative strategies to reduce the invasiveness of the surgical approach need to be developed. External snaring of the caval veins in re-do patients is hazardous when a minimally-invasive approach is used because the tissues are usually fragile and sudden bleeding can be difficult to control. We propose a simple strategy using Foley catheters to provide 'internal snaring' of both caval veins, avoiding surgical dissection of the adhesions around the vessels. Three re-do patients were operated on for combined mitral/tricuspid surgery using internal snaring: the occlusion of the veins was satisfactory in all cases, with no complications reported so far. Even though the 'trick' described is not spectacular, it might be very helpful to be prepared to use this technique either on a routine basis or in special situations when the risk of injury to the atrial or caval structures appears to be increased. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.