FIND YOUR IDEAL CARDIOPLEGIA CANNULAE DELIVERING MYOCARDIAL PROTECTION

FIND YOUR IDEAL CARDIOPLEGIA CANNULAE DELIVERING MYOCARDIAL PROTECTION

WHAT IS YOUR IDEAL CARDIOPLEGIA STRATEGY? FINDING THE RIGHT CANNULAE You re facing a nearly endless range of procedural scenarios and ever-increasing variability in the operating room, requiring sets of cardioplegia cannulae which offer incredible breadth and depth. More than ever, your cardiovascular team is tasked with delivering a high level of myocardial protection for standard and minimally invasive cases.

FINDING THE RIGHT CARDIOPLEGIA SCHEME Whether a continuous or intermittment cardioplegia approach, or a cold, warm or normothermic delivery, your cannulation scheme includes many considerations. By accessing the largest portfolio of cardioplegia cannulae today, your decisions can be based on more options so you can treat more patients. At Medtronic, we re working for you, bringing you the tools and technologies that you ve asked for find your ideal cardioplegia cannulae today. CONSIDER ALL YOUR OPTIONS A specific cannulation scheme must be created for each operation. 1

FIND YOUR IDEAL SOLUTION FOR STANDARD CASES Your standard case is anything but standard and we know it. Medtronic offers the largest portfolio of cardioplegia cannulae to treat your patients as they present with ever varying disease states and anatomies. DLP Silicone RCSP Cannulae with Elongated Manual-Inflate Cuff RETROGRADE DLP High Flow Coronary Artery Ostial Cannulae Hand-held or clamped placement options allow infusion directly into the coronary arteries. Clinical settings may include, AVR, ascending aortic arch resection or other surgical procedures where the ascending aortic arch is incised. LONG BALLOON DLP Silicone Coronary Artery Ostial Cannulae Intracoronary application offers an alternate cannulation strategy and improves visualization of the aortic root. The elongated balloon limits a shunting effect Clinical studies suggest that standard coronary sinus perfusion techniques allow a portion of the retrograde cardioplegia to be shunted away from the capillary vessels, depriving them of nutritive cardioplegia flow. 2 By using a cannulae with an elongated balloon to block the middle cardiac vein (through which the undesired shunting takes place), cardioplegia is directed to the capillary beds, providing for improved myocardial distribution in the free wall of the left ventricle and a more uniform temperature gradient. 2 DLP Dual Lumen Aortic Root Cannulae with Vent Line Dual lumen tip with vent line allows simultaneous administration of cardioplegia delivery and left heart venting so, there s no need to discontinue cardioplegia delivery while aspirating air. Important Safety Information For a listing of indications, contraindications, precautions and warnings, please refer to the Instructions for Use. Care and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other cardiac surgery procedures. Care and caution should be taken when inserting the needle to prevent perforation of the back wall of the aorta. Extreme caution should be exercised while introducing the cannula into the coronary sinus as this may cause vessel damage. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

MAXIMIZE PROTECTION FOR YOUR MINIMALLY INVASIVE CASES Just because your operation is minimally invasive, doesn t mean you should provide less protection. Complex MICS procedures and those with anticipated longer cross clamp times do require enhanced myocardial protection. 3 Medtronic provides options specifically designed to help you maneuver in your minimally invasive incisions. MiAR Cannulae (Minimally Invasive Aortic Root) Notably long, at 12.25 inches and just right for facilitating placement through a ministernotomy or right thoracotomy. The MiAR maintains hemostasis and allows retraction of the needle point into a rigid fitting after placement of the cannulae. RETROGRADE MiRCSP Cannulae (Minimally Invasive Coronary Sinus Perfusion) Provides enhanced visibility and manueverability 4 to aid insertion in MICS procedures where a standard retrograde cannula is difficult to insert. 3 When you re making important decisions, keep in mind that the basic tenets of myocardial protection apply to both standard and MICS procedures. 5 Important Safety Information Extreme caution should be exercised while introducing the cannulae into the coronary sinus. Do not force the cannulae into the coronary sinus as this may cause vessel damage. Additional care and caution may be necessary due to the unique adaptations required for minimally invasive techniques. Due to limitations of direct visualization during minimally invasive techniques, echocardiographic or fluoroscopic imaging is recommended. Care and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other cardiac surgery procedures. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.

IMPROVE YOUR MYOCARDIAL PROTECTION. Antegrade and retrograde cardioplegia work together to protect the heart in more 3, 7, 11 than one way. Continuous retrograde cardioplegia is particularly useful for coronary reoperations and provides adequate myocardial protection when combined with antegrade delivery. 10 RETROGRADE The simultaneous technique of combined cardioplegia keeps the heart decompressed and vented, washes atheroemboli from veins and arteries, and provides uniform myocardial protection. 10 Clinical discovery can help you look across the many options available. There may be more than one way, indeed.

RETROGRADE DLP Silicone RCSP Cannulae with Manual-Inflate Cuff Silicone manual-inflate cuffs with pressure monitoring lines feature a smooth cuff for easy placement, or ridged cuff for enhanced retention. Choose from standard sized or elongated for enhanced retention and occlusion of middle cardiac vein. Using retrograde cardioplegia in conjunction with antegrade delivery conserves time and reduces mortality. 7,8,9,10 DLP Silicone RCSP Cannulae with Auto-Inflate Cuff Silicone auto-inflate cuffs offer the convenience of cuff inflation without the need for a syringe. The unique flow-through design allows cardioplegia to circulate through the cuff before exiting the cannula tip. DLP Aortic Root Cannulae Aortic root pressure monitoring and left heart venting. All DLP Aortic Root Cannulae can be used to aspirate emboli as well as to administer cardioplegia. Important Safety Information Care and caution should be taken when inserting the needle to prevent perforation of the back wall of the aorta. Care and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other cardiac surgery procedures. Additional care and caution may be necessary due to the unique adaptations required for minimally invasive cardiac surgery. Extreme caution should be exercised while introducing the cannula into the coronary sinus. Do not force the cannula into the coronary sinus as this may cause vessel damage. Do not over inflate the balloon. Caution: Federal Law (USA) restricts this device to sale or on the order of a physician. Simultaneous delivery revealed the most consistent results and the best perfusion of the anterior left ventricle and right ventricle in comparison to antegrade or retrograde routes. 6

CANNULAE ORDERING INFORMATION MiAR Cannulae 12.25 in (31 cm) overall length 11012L 11014L Flanged Standard Tip and Flow-Guard Introducer 12 ga (9 Fr) 14 ga (7 Fr) DLP Aortic Root Cannulae 2.5 in (6.4 cm) overall length Flanged Standard Tip and Standard Introducer 18 ga (4 Fr) white tip 10218 and clear flange 18 ga (4 Fr) blue onepiece tip and flange 12218 DLP Aortic Root Cannulae with Vent Line 5.5 in (14.0 cm) overall length Flanged Stardard Tip and Standard Introducer 20009 9 ga (11 Fr) 20012 12 ga (9 Fr) 12 ga (9 Fr) 20012S with two clamps DLP Coronary Artery Ostial Cannulae 6 in (15.2 cm) overall length Basket Tip 30010 10 Fr (3.3 mm) 30012 12 Fr (4.0 mm) 20014 14 Fr (4.7 mm) Important Safety Information Antegrade Cannulae: Care should be taken when inserting the needle to prevent perforation of the back wall of the aorta. Care and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other cardiac surgery procedures. Additional care and caution may be necessary due to the unique adaptations required for minimally invasive techniques. For a listing of indications, contraindications, precautions and warnings, please refer to the Instructions for Use. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. DLP Dual Lumen Aortic Root Cannulae with Vent Line 3.25 in (8.3 cm) overall length Standard Tip 30401 12 ga (9 Fr) Flanged Standard Tip 30402 12 ga (9 Fr) DLP Cardioplegia Needles Neonatal - 6.5 in (16.5 cm) overall length Tip Length 1/4 in (0.64 cm) with Hub Stop 11316 16 ga (5 Fr) Adult 10 in (25.4 cm) overall length Tip Length 5/8 in (1.59 cm) with 4 Side Holes and Flange Stop 10313 13 ga (8 Fr) DLP Silicone Coronary Artery Ostial Cannulae 10 in (25.4 cm) overall length 30315 bulb 30317 17 Fr (5.7 mm) bulb 30320 20 Fr (6.7 mm) bulb 5.5 in (14.0 cm) overall length Flanged Stardard Tip and Standard Introducer 10009 9 ga (11 Fr) 10012 12 ga (9 Fr) 10014 14 ga (7 Fr) 10016 16 ga (5 Fr) 10018 18 ga (4 Fr) Flanged Standard Tip and Flow-Guard Introducer 11012 12 ga (9 Fr) 11014 14 ga (7 Fr) 5.75 in (14.6 cm) overall length Slotted Long Tip and Standard Introducer 10112 12 ga (9 Fr) 10114 14 ga (7 Fr) Long Tip and Standard Introducer 10114B 14 ga (7 Fr) Flanged Long Tip and Standard Introducer 10112WF 12 ga (9 Fr) 10114WF 14 ga (7 Fr) 5.25 in (13.3 cm) overall length Flanged Pressure Monitoring Tip and Standard Introducer 23009 9 ga (11 Fr) 20014 14 ga (7 Fr) 20014L 14 ga (7 Fr) 8 in (20.3 cm) vent line 20016 16 ga (5 Fr) Flanged Standard Tip and Flow-Guard Introducer 21012 12 ga (9 Fr) 21014 14 ga (7 Fr) 5.75 in (14.6 cm) overall length Slotted Long Tip and Standard Introducer 20112 12 ga (9 Fr) 20114 14 ga (7 Fr) Long Tip and Standard Introducer 20112B 12 ga (9 Fr) 20114B 14 ga (7 Fr) Flanged Long Tip and Standard Introducer 20114WF 14 ga (7 Fr) 14 ga (7 Fr) 20114WF with side holes 5.25 in (13.3 cm) overall length Flanged Pressure Monitoring Tip and Standard Introducer 24009 9 ga (11 Fr) Spherical Tip 30011 Soft, Concave Tip 30050 Soft, Convex Tip 30055 DLP High Flow Coronary Artery Ostial Cannulae 7.5 in (19.1 cm) overall length 90 Angle Tip 30110 10 Fr (3.3 mm) 30112 12 Fr (4.0 mm) 20114 14 Fr (4.7 mm) 90 Angle Soft Silicone Tip 30155 10 Fr (3.3 mm) 45 Angle Tip 30212 12 Fr (4.0 mm) 45 Angle Soft Silicone Tip 30255 10 Fr (3.3 mm)

RETROGRADE CANNULAE ORDERING INFORMATION Important Safety Information Retrograde Cannulae: Extreme caution should be exercised while introducing the cannula into the coronary sinus. Do not force the cannula into the coronary sinus as this may cause vessel damage. Do not over inflate the balloon. Additional care and caution may be necessary due to the unique adaptations required for minimally invasive techniques. Due to limitations of direct visualization during minimally invasive techniques, echocardiographic or fluoroscopic imaging is recommended. Care and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other cardiac surgery procedures. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. MiRCSP Cannulae 12.5 in (31.8 cm) overall length Tip Deflecting Thoracotomy 94113 TDT 13 Fr manual-inflate cuff 94533 TDT 13 Fr auto-inflate cuff Tip Deflecting 94113 TD 13 Fr manual-inflate cuff 94533 TD 13 Fr auto-inflate cuff (2 per carton) Gundry Silicone RCSP Cannulae with Manual-Inflate Cuff 9 in (22.9 cm) overall length Smooth Cuff and Wirewound Body 10 Fr (3.3 mm) 94110 12.5 in (31.8 cm) overall length Smooth Cuff, Wirewound Body, 13 Fr (4.3 mm) 94113T 94615 94715 Smooth Cuff and Wirewound Body 94115T DLP Silicone RCSP Cannulae with Manual-Inflate Cuff 9 in (22.9 cm) overall length Smooth Cuff and Wirewound Body 94010 10 Fr (3.3 mm) no stylet 9.5 in (24.1 cm) overall length Smooth Cuff, Non-Wirewound Body, 94006 6 Fr (2.0 mm) no stylet 94106 6 Fr (2.0 mm) 12.5 in (31.8 cm) overall length Smooth Cuff and Wirewound Body 94015 no stylet 94215T solid stylet Smooth Cuff, Wirewound Body, solid stylet 94725 Preformed Cuff and Wirewound Body 94515 94525 solid stylet Elongated Cuff, Wirewound Body, 94625 solid stylet 94665 DLP Silicone RCSP Cannulae with Manual-Inflate Cuff (continued) 12.5 in (31.8 cm) overall length Ridged Cuff, Wirewound Body, 13 Fr (4.3 mm) 94913 13 Fr (4.3 mm) guidewire stylet and 6 in (15.2 cm) 94913L pressure monitoring and inflation line 94915 94965 solid stylet 94975 DLP Silicone RCSP Cannulae with Auto-Inflate Cuff 12.5 in (31.8 cm) overall length Smooth Preformed Cuff and Wirewound Body 94315T solid stylet 94415T solid stylet 94735 94745 Ridged Preformed Cuff, Wirewound Body, solid stylet 94985 94995 DLP PVC RCSP Cannulae with Auto-Inflate Cuff 10 in (25.4 cm) overall length Smooth Preformed Cuff, Short Fluted, Bullet Nosed Tip, solid stylet 94885K 11 in (27.9 cm) overall length Smooth Preformed Cuff, Multi-Port Tip, 13 Fr (4.3 mm) 94523 with mini Tru-Touch handle 13 Fr (4.3 mm) solid stylet 94533 solid stylet 94535 12 in (30.5 cm) length Smooth Preformed Cuff, Short Fluted, Bullet Nosed Tip, solid stylet 94885 94895 12.5 in (31.8 cm) length Smooth Preformed Cuff, Fluted, Bullet Nosed Tip, solid stylet 94835 with Tru-Touch handle 94845 Ridged Preformed Silicone Cuff, Short Fluted, Bullet Nosed Tip, solid stylet 94935 94945

For more information, contact your local Medtronic Cannula Products Representative. U.S. Customer Service: 1 (800) 328-1357. Some products may not be available in all geographies. References 1. Balaram, Sandhya K. et al. Minimally invasive perfusion techniques. In: Mongero LB, Beck JR eds. On Bypass: Advanced Perfusion Techniques. Totowa, NJ. Humana Press. 2008:141-170. 2. Bezon E, Barra JA, Mondine P, Karaterki A. Retrograde cold blood cardioplegia. Obliteration of the posterior interventricular vein in the coronary sinus improves cooling of the left ventricle posterior wall. Cardiovasc Surg. Dec. 1997; 5(6):620-625. 3. Pretre R, Turina M. Myocardial protection in minimally invasive valvular surgery In: Salerno TA, Ricci M, eds. Myocardial Protection. Elmsford, NY. Blackwell Futura. 2004:174-180. 4. Medtronic data on file 5. Chitwood WR Jr, Wixon CL, Elbeery JR, Francalancia NA, Lust RM, et al. Minimally invasive cardiac operation: Adapting cardioprotective strategies. Ann Thorac Surg. 1999; 68:1974-1977. 6. Cohen G, Borger MA, Weisel RD, Vivek R. Intraoperative myocardial protection: Current trends and future perspectives. Ann Thorac Surg. 1999; 68:1995-2001. 7. Buckberg GD, Beyersdorf F, Allen BS, Robertson JM. Integrated myocardial management: Background and initial application. J Cardiac Surg. 1995; 10:68-89. 8. Borger MA, Roa V, Weisel RD, et al. Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia. J Thorac Cardiovasc Surg. Jan. 2001; 121: 83-90. 9. Ascione R, Suleiman SM, Angelini GD, Retrograde Hot-Shot Cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement. Ann Thorac Surg. Feb. 2008; 85(2):454-458. 10. Fazel S, Borger MA, Weisel RD, et al. Myocardial protection in reoperative coronary artery bypass grafting: Toward decreasing morbidity and mortality. J Card Surg. 2004; 19:291-295. 11. Scholl FG, Drinkwater DC. Antegrade, retrograde, or both. In: Salerno TA, Ricci M, eds. Myocardial Protection. Elmsford, NY. Blackwell Futura. 2004:82-87. Trademarks may be registered and are the property of their respective owners. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879 Toll-free: 1 (800) 328-2518 (technical support for physicians and medical professionals) findyourideal.medtronic.com UC201601758 EN 2015 Medtronic 09/2015