• Cataldo Labriola, Domenico Paparella, Giuseppe Labriola, Pierpaolo Dambruoso, Mauro Cassese, and Giuseppe Speziale.
• Department of Cardiac Anesthesia, Santa Maria Hospital-GVM Care & Research, Bari, Italy. Electronic address: dino.labriola@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2017 Aug 1; 31 (4): 1203-1209.

ObjectivesEvaluating the efficacy of 2 new percutaneous devices specifically designed to be placed through the right internal jugular vein, therefore named "necklines," for achieving retrograde cardioplegia and pulmonary venting in the setting of minimally invasive aortic valve replacement (MIAVR).DesignCase series.SettingUniversity-affiliated private hospital.ParticipantsPatients undergoing MIAVR.InterventionsNecklines were placed by the anesthesiologist using transesophageal electrocardiography, with pressure guidance before the surgical procedure was initiated.Measurements And Main ResultsThe records of 51 consecutive patients who underwent MIAVR with necklines placement were reviewed retrospectively. The access for MIAVR was through either a J-hemisternotomy or a right anterior thoracotomy. The efficacy of the 2 catheters, successful placement rate, time needed to deploy catheters, and perioperative complications were recorded. Necklines were placed successfully in all patients in 23±13 minutes. A total of 110 doses of retrograde cardioplegia were delivered at a mean flow rate of 173±35 mL/min and a mean pressure of 41±6 mmHg. The pulmonary catheter ensured venting of the heart that was graded by surgeons as "excellent" in 33 patients, "sufficient" in 12 patients, and "not adequate" in 2 patients. There were no major adverse events or deaths.ConclusionsNecklines ensure effective retrograde cardioplegia and venting of the heart, provide optimal surgical vision and access during MIAVR, and allow surgeons to operate in an unobstructed surgical field. Nevertheless, additional studies are required to determine whether the use of necklines is associated with better outcomes than those with conventional methods.Copyright © 2017 Elsevier Inc. All rights reserved.

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