FIND YOUR IDEAL CARDIOPLEGIA CANNULAE

DELIVERING MYOCARDIAL PROTECTION WHAT IS YOUR IDEAL CARDIOPLEGIA FINDING THE RIGHT CANNULAE STRATEGY? 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. RETROGRADE Using retrograde cardioplegia in conjunction with antegrade delivery

DLP™ Silicone RCSP Cannulae with Manual-Inflate Cuff conserves time and 7-10 Silicone manual-inflate cuffs with pressure monitoring lines feature a smooth cuff reduces mortality. for easy placement or ridged cuff for enhanced retention. Choose from standard sized or elongated for enhanced retention and occlusion of middle cardiac .

™ 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.

ANTEGRADE “ Simultaneous delivery revealed the most consistent results and the best of the DLP™ Aortic Root Cannulae

Aortic root pressure monitoring and left venting. All DLP aortic root cannulae anterior left can be used to aspirate emboli as well as to administer cardioplegia. and right ventricle in

Important Safety Information comparison to antegrade Care and caution should be taken when inserting the needle to prevent perforation of the back wall of the . Care or retrograde routes.”6 and caution should be taken to avoid damage to vessels and cardiac tissue during cannulation or other 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. MiAR™ Cannulae DLP™ Aortic Root Cannulae DLP™ Aortic Root Cannulae DLP™ Coronary ANTEGRADE 12.25 in (31 cm) overall length 2.5 in (6.4 cm) overall length with Vent Line Ostial Cannulae Flanged Standard Tip and Flanged Standard Tip and 5.5 in (14.0 cm) overall length 6 in (15.2 cm) overall length Flow-Guard™ Introducer Standard Introducer CANNULAE Flanged Stardard Tip and Basket Tip 18 ga (4 Fr) white tip Standard Introducer 11012L 12 ga (9 Fr) 10218 and clear flange 30010 10 Fr (3.3 mm) ORDERING 11014L 14 ga (7 Fr) 20009 9 ga (11 Fr) 18 ga (4 Fr) blue one- 12218 30012 12 Fr (4.0 mm) INFORMATION (10 per carton) piece tip and flange 20012 12 ga (9 Fr) 20014 14 Fr (4.7 mm) (20 per carton) 12 ga (9 Fr) 20012S DLP™ Dual Lumen Aortic with two clamps (20 per carton) Root Cannulae with Vent 5.5 in (14.0 cm) overall length 20014 14 ga (7 Fr) Spherical Tip Flanged Stardard Tip and 14 ga (7 Fr) Line 20014L 30011 (20 per carton) Standard Introducer 8 in (20.3 cm) vent line 3.25 in (8.3 cm) overall length Soft, Concave Tip 10009 9 ga (11 Fr) 20016 16 ga (5 Fr) Standard Tip 30050 (10 per carton) 10012 12 ga (9 Fr) Flanged Standard Tip and 30401 12 ga (9 Fr) Flow-Guard™ Introducer 10014 14 ga (7 Fr) Soft, Convex Tip 21012 12 ga (9 Fr) 30055 (10 per carton) ™ 10016 16 ga (5 Fr) DLP Cardioplegia Needles 21014 14 ga (7 Fr) Pediatric - 6.5 in (16.5 cm) overall length 10018 18 ga (4 Fr) (20 per carton) DLP™ High Flow Coronary Tip Length 1/4 in (0.64 cm) with Hub Stop Flanged Standard Tip and Flow-Guard™ Introducer Artery Ostial Cannulae 11316 16 ga (5 Fr) 5.75 in (14.6 cm) overall length 11012 12 ga (9 Fr) 7.5 in (19.1 cm) overall length (20 per carton) Slotted Long Tip and Standard Introducer 11014 14 ga (7 Fr) 90° Angle Tip 20112 12 ga (9 Fr) Adult –10 in (25.4 cm) overall length (20 per carton) 30110 10 Fr (3.3 mm) 20114 14 ga (7 Fr) Tip Length 5/8 in (1.59 cm) 30112 12 Fr (4.0 mm) with 4 Side Holes and Flange Stop 5.75 in (14.6 cm) overall length Flanged Long Tip and Standard Introducer 20114 14 Fr (4.7 mm) 10313 13 ga (8 Fr) Slotted Long Tip and Standard Introducer 20114WF 14 ga (7 Fr) 90° Angle Soft Silicone Tip (20 per carton) 10112 12 ga (9 Fr) 14 ga (7 Fr) 20114WF with side holes 30155 10 Fr (3.3 mm) 10114 14 ga (7 Fr) ™ (20 per carton) 45° Angle Tip DLP Silicone Coronary Long Tip and Standard Introducer Important Safety Information Artery Ostial Cannulae (20 per carton) 30212 12 Fr (4.0 mm) Antegrade Cannulae: Care should be taken when 5.25 in (13.3 cm) overall length 10 in (25.4 cm) overall length inserting the needle to prevent perforation Flanged Pressure Monitoring Tip and 45° Angle Soft Silicone Tip 30315 15 Fr (5.0 mm) bulb 5.25 in (13.3 cm) overall length Standard Introducer of the back wall of the aorta. Care and caution 30255 10 Fr (3.3 mm) should be taken to avoid damage to vessels 30317 17 Fr (5.7 mm) bulb Flanged Pressure Monitoring Tip and 24009 9 ga (11 Fr) and cardiac tissue during cannulation or other Standard Introducer (10 per carton) (20 per carton) cardiac surgery procedures. Additional care 30320 20 Fr (6.7 mm) bulb 23009 9 ga (11 Fr) and caution may be necessary due to the (10 per carton) (20 per carton) 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. MiRCSP™ Cannulae DLP™ Silicone RCSP DLP™ Silicone RCSP DLP™ PVC RCSP Cannulae RETROGRADE 12.5 in (31.8 cm) overall length Cannulae with Cannulae with with Auto-Inflate Cuff Tip Deflecting Thoracotomy Manual-Inflate Cuff Manual-Inflate Cuff 10 in (25.4 cm) overall length CANNULAE 94113 TDT 13 Fr manual-inflate cuff 9 in (22.9 cm) overall length (continued) Smooth Preformed Cuff, Short Fluted, Bullet Nosed Tip, and Integral Stopcock Smooth Cuff and Wirewound Body 12.5 in (31.8 cm) overall length 94533 TDT 13 Fr auto-inflate cuff Ridged Cuff, Wirewound Body, 15 Fr (5.0 mm) solid stylet ORDERING 94010 10 Fr (3.3 mm) no stylet 94885K ™ (2 per carton) and Integral Stopcock with Tru-Touch handle INFORMATION (4 per carton) 13 Fr (4.3 mm) (10 per carton) 94913 Gundry™ Silicone guidewire stylet 9.5 in (24.1 cm) overall length 11 in (27.9 cm) overall length RCSP Cannulae with 13 Fr (4.3 mm) guidewire stylet and 6 in (15.2 cm) Smooth Preformed Cuff, Multi-Port Tip, Smooth Cuff, Non-Wirewound Body, 94913L Manual-Inflate Cuff and Integral Stopcock pressure monitoring and and Integral Stopcock 9 in (22.9 cm) overall length inflation line 94006 6 Fr (2.0 mm) no stylet 13 Fr (4.3 mm) solid stylet 94533 ™ Smooth Cuff and Wirewound Body 15 Fr (5.0 mm) with Tru-Touch handle 6 Fr (2.0 mm) 94915 94106 guidewire stylet 15 Fr (5.0 mm) solid stylet 10 Fr (3.3 mm) guidewire stylet 94535 94110 with Tru-Touch™ handle guidewire stylet 15 Fr (5.0 mm) (4 per carton) 94965 guidewire stylet (10 per carton) (4 per carton) with Tru-Touch™ handle 12.5 in (31.8 cm) overall length 15 Fr (5.0 mm) solid stylet 12 in (30.5 cm) length 12.5 in (31.8 cm) overall length 94975 ™ Smooth Cuff and Wirewound Body with Tru-Touch handle Smooth Preformed Cuff, Short Fluted, Smooth Cuff, Wirewound Body, (10 per carton) Bullet Nosed Tip, and Integral Stopcock and Integral Stopcock 94215T 15 Fr (5.0 mm) solid stylet 15 Fr (5.0 mm) solid stylet 13 Fr (4.3 mm) (10 per carton) 94885 94113T ™ guidewire stylet DLP™ Silicone RCSP with Tru-Touch handle Smooth Cuff, Wirewound Body, (10 per carton) and Integral Stopcock Cannulae with 15 Fr (5.0 mm) 94895 guidewire stylet 15 Fr (5.0 mm) 15 Fr (5.0 mm) solid stylet Auto-Inflate Cuff with Tru-Touch™ handle 94615 94725 guidewire stylet with Tru-Touch™ handle 12.5 in (31.8 cm) overall length (10 per carton) (4 per carton) (10 per carton) Smooth Preformed Cuff and Wirewound Body 15 Fr (5.0 mm) Elongated Cuff, Wirewound Body, 12.5 in (31.8 cm) length 94715 guidewire stylet and Integral Stopcock 94315T 15 Fr (5.0 mm) solid stylet with Tru-Touch™ handle Smooth Preformed Cuff, Fluted, 15 Fr (5.0 mm) Bullet Nosed Tip, and Integral Stopcock 94625 15 Fr (5.0 mm) solid stylet 94415T (10 per carton) guidewire stylet 15 Fr (5.0 mm) solid stylet 15 Fr (5.0 mm) 94835 Smooth Cuff and Wirewound Body 94665 15 Fr (5.0 mm) solid stylet with Tru-Touch™ handle guidewire stylet 94735 with Tru-Touch™ handle Important Safety Information 15 Fr (5.0 mm) Ridged Preformed Silicone Cuff, 94115T (10 per carton) Retrograde Cannulae: Extreme caution should guidewire stylet 15 Fr (5.0 mm) Short Fluted, Bullet Nosed Tip, 94745 guidewire stylet and Integral Stopcock be exercised while introducing the cannula into (10 per carton) with Tru-Touch™ handle the coronary sinus. Do not force the cannula 15 Fr (5.0 mm) solid stylet 94935 ™ into the coronary sinus as this may cause vessel Ridged Preformed Cuff, Wirewound Body, with Tru-Touch handle damage. Do not over inflate the balloon. Additional and Integral Stopcock (10 per carton) care and caution may be necessary due to the 15 Fr (5.0 mm) unique adaptations required for minimally 94995 guidewire stylet with Tru-Touch™ handle invasive techniques. Due to limitations of direct visualization during minimally invasive techniques, (10 per carton) 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. FIND YOUR IDEAL SOLUTION DLP™ Silicone RCSP Cannulae with FOR STANDARD CASES Elongated Manual-Inflate Cuff

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. RETROGRADE

ANTEGRADE

LONG BALLOON DLP™ High Flow Coronary Artery Ostial Cannulae

Hand-held or clamped placement options allow infusion directly into the coronary . Clinical settings may include, AVR, ascending aortic arch resection, or other surgical procedures where the ascending aortic arch is incised.

ANTEGRADE

DLP™ Silicone Coronary Artery Ostial Cannulae

Intracoronary application offers an alternate cannulation The elongated balloon limits a shunting effect strategy and improves visualization of the aortic root. 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 2 ANTEGRADE ventricle and a more uniform temperature gradient.

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 DLP™ Dual Lumen Aortic Root Cannulae with Vent Line should be taken when inserting the needle to prevent perforation of the back wall of the Dual lumen tip with vent line allows simultaneous administration of cardioplegia aorta. Extreme caution should be exercised while introducing the cannula into the coronary delivery and left heart venting, so there’s no need to discontinue cardioplegia sinus as this may cause vessel damage. Caution: Federal law (USA) restricts this device to delivery while aspirating air. 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.

ANTEGRADE

MiAR™ Cannulae (Minimally Invasive Aortic Root)

Notably long, at 12.25 inches — and just right for facilitating placement through a mini- sternotomy 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 manueverability4 to aid insertion in MICS procedures where a standard retrograde cannula is difficult to insert.3

Important Safety Information When you’re making important decisions, 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. keep in mind that the basic tenets of Additional care and caution may be necessary due to the unique adaptations required for myocardial protection apply to both minimally invasive techniques. Due to limitations of direct visualization during minimally 5 invasive techniques, echocardiographic or fluoroscopic imaging is recommended. Care and standard and MICS procedures. 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 ANTEGRADE together to protect the heart in more than one way.3, 7, 11

RETROGRADE Continuous retrograde cardioplegia is particularly useful for coronary reoperations and provides adequate myocardial protection when combined with antegrade delivery.10

The simultaneous technique of combined cardioplegia keeps the heart decompressed and vented, washes atheroemboli from 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. CONSIDER ALL YOUR

FINDING THE RIGHT OPTIONS CARDIOPLEGIA SCHEME A specific cannulation Whether a continuous or intermittment scheme must be created cardioplegia approach or a cold, warm, or for each operation.1 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. For more information, contact your local Medtronic Cannula Products Representative. U.S. Customer Service: (800) 328-1357. Not all products are approved in every geography.

References 1 Balaram, Sandhya K. et al. Minimally invasive perfusion techniques. In: Mongero LB, Beck JR 7 Buckberg GD, Beyersdorf F, Allen BS, Robertson JM. Integrated myocardial management: eds. On Bypass: Advanced Perfusion Techniques. Totowa, NJ. Humana Press. 2008:141-170. background and initial application. J Card Surg. January 1995;10(1):68-89. 2 Bezon E, Barra JA, Mondine P, Karaterki A. Retrograde cold blood cardioplegia. Obliteration of 8 Borger MA, Rao V, Weisel RD, et al. Reoperative coronary bypass surgery: effect of patent the posterior interventricular vein in the coronary sinus improves cooling of the left ventricle grafts and retrograde cardioplegia. J Thorac Cardiovasc Surg. January 2001;121(1):83-90. posterior wall. Cardiovasc Surg. December 1997;5(6):620-625. 9 Ascione R, Suleiman SM, Angelini GD. Retrograde hot-shot cardioplegia in patients with left 3 Pretre R, Turina M. Myocardial protection in minimally invasive valvular surgery In: Salerno TA, ventricular hypertrophy undergoing aortic . Ann Thorac Surg. February Ricci M, eds. Myocardial Protection. Elmsford, NY. Blackwell Futura. 2004:174-180. 2008;85(2):454-458. 4 Medtronic data on file. 10 Fazel S, Borger MA, Weisel RD, et al. Myocardial protection in reoperative coronary artery bypass grafting. J Card Surg. July-August 2004;19(4):291-295. 5 Chitwood WR Jr, Wixon CL, Elbeery JR, et al. Minimally invasive cardiac operation: adapting cardioprotective strategies. Ann Thorac Surg. November 1999;68(5):1974-1977. 11 Scholl FG, Drinkwater DC. Antegrade, retrograde, or both. In: Salerno TA, Ricci M, eds. Myocardial Protection. Elmsford, NY. Blackwell Futura. 2004:82-87. 6 Cohen G, Borger MA, Weisel RD, Rao V. Intraoperative myocardial protection: current trends and future perspectives. Ann Thorac Sur. November 1999;68(5):1995-2001.

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