1
|
Sun Y, Luo X, Yang X, Zhu X, Yang C, Pan T, Du Y, Zhang R, Wang D. Benefits and risks of intermittent bolus erector spinae plane block through a catheter for patients after cardiac surgery through a lateral mini-thoracotomy: A propensity score matched retrospective cohort study. J Clin Anesth 2021; 75:110489. [PMID: 34481363 DOI: 10.1016/j.jclinane.2021.110489] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE A lateral mini-thoracotomy approach to cardiac surgery causes severe and complicated postoperative pain compared to the sternotomy approach. In this study we assessed the benefits and risks of intermittent bolus erector spinae plane block (ESPB) via a catheter for patients who underwent cardiac surgery through a lateral mini-thoracotomy. DESIGN A propensity score-matched retrospective cohort study. SETTING University hospital. PATIENTS 452 consecutive patients that underwent cardiac surgery through a lateral mini-thoracotomy from 2018 to 2020. INTERVENTIONS Patients who received intermittent bolus ESPB through a catheter for 3 days (ESPB group, n = 93) were compared with patients who did not receive any regional anesthesia (Control group, n = 174) after propensity score matching. MEASUREMENTS The primary endpoint was postoperative in-hospital cumulative opioid consumption (calculated as oral morphine milligram equivalents, MME). The secondary outcomes were intraoperative sufentanil doses, therapeutic use of antiemetic, pulmonary infection (assessed using a modified clinical pulmonary infection score, CPIS), durations of ICU and hospital stays, and ESPB related/unrelated complications. MAIN RESULTS There is a lower oral MME in the ESPB group, 266 ± 126 mg in the ESPB group vs. 346 ± 105 mg in the control group (95% CI -113 to -46; P < 0.01). Fewer patients received therapeutic antiemetic agents in the ESPB group (30% vs. 42%, odds ratio 0.58; 95% CI 0.34 to 0.99; P = 0.04). The modified CPIS in the ESPB group is lower: 1.4 ± 0.9 vs. 2.0 ± 1.0 (95% CI -0.9 to -0.3; P < 0.01) on postoperative day 1; 1.6 ± 0.9 vs. 2.0 ± 0.9 (95% CI -0.7 to -0.2; P < 0.01) on postoperative day 2. The observed complications associated with ESPB include pneumothorax (1%), staxis around stomas (5%), hypotension (1%), catheter displacement (3%), and catheter obstruction (2%). None of the patients had any adverse outcomes. CONCLUSION Intermittent bolus ESPB is relatively safe and correlated with a reduction in the use of opioids and antiemetics for cardiac surgery through a lateral mini-thoracotomy.
Collapse
Affiliation(s)
- Yanhua Sun
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuan Luo
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuelin Yang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Xuewen Zhu
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Can Yang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Tuo Pan
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Yingjie Du
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No.1 Dongjiaominxiang Road, Dongchen District, Beijing, 100730, China
| | - Rui Zhang
- Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing, University Medical School, 321 Zhongshan Road, Nanjing 210008, China.
| |
Collapse
|
2
|
Chernov I, Enginoev S, Koz'min D, Magomedov G, Tarasov D, Sá MPBO, Weymann A, Zhigalov K. Minithoracotomy vs. Conventional Mitral Valve Surgery for Rheumatic Mitral Valve Stenosis: a Single-Center Analysis of 128 Patients. Braz J Cardiovasc Surg 2020; 35:185-190. [PMID: 32369299 PMCID: PMC7199974 DOI: 10.21470/1678-9741-2019-0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the in-hospital outcomes of a right-sided anterolateral minithoracotomy with those of median sternotomy in patients who received a mitral valve replacement (MVR) because of rheumatic mitral valve stenosis (RMS). Methods This is a retrospective analysis of 128 patients (34% male) with RMS between 2011 and 2015. The median age was 53 years (45; 56). The mean ejection fraction was 58.4±6.3%. All the subjects were divided into two groups - Group 1 contained 78 patients who underwent MVR via minithoracotomy (MT-MVR), while Group 2 contained 50 patients who underwent MVR via median sternotomy (S-MVR). Results In the MT-MVR group, a mechanical prosthesis was implanted in 72% of cases, while it was implanted in 90% of cases in the S-MVR group (P=0.01). The duration of myocardial ischemia was similar (MT-MVR, 77±24 min; S-MVR, 70±18 min) (P=0.09). However, the cardiopulmonary bypass time was lower in the S-MVR group than in the MT-MVR group (99±24 min and 119±34 min, respectively) (P≤0.001). There was no difference in the duration of mechanical ventilation, intensive care unit stay, and hospitalization period. Postoperative blood loss was lower in the MT-MVR group (P≤0.001) than in the S-MVR group. There are no statistically significant differences in postoperative complications (superficial wound infection, stroke, delirium, pericardial tamponade, pleural puncture, acute kidney insufficiency, and implantation of pacemaker). The overall in-hospital mortality was 3.9% (P=0.6) Conclusion The minimally invasive approach for RMS is feasible and has an excellent cosmetic effect without increasing the risk of surgical complications.
Collapse
Affiliation(s)
- Igor Chernov
- Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Soslan Enginoev
- Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Astrakhan State Medical University Department of Cardiovascular Surgery Astrakhan Russia Department of Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Russia
| | - Dmitry Koz'min
- Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Gasan Magomedov
- Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Dmitry Tarasov
- Federal Center for Cardiovascular Surgery Department of Cardiac Surgery Astrakhan Russia Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Michel Pompeu B O Sá
- Pronto Socorro Cardiológico de Pernambuco - PROCAPE Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, PE, Brazil
| | - Alexander Weymann
- University Duisburg-Essen University Hospital of Essen West German Heart and Vascular Center Essen Essen Germany Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- University Duisburg-Essen University Hospital of Essen West German Heart and Vascular Center Essen Essen Germany Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
3
|
Shcherbatyuk KV, Komarov RN, Pidanov OY. [Right thoracotomy approach for minimally invasive mitral valve surgery]. Khirurgiia (Mosk) 2019:121-125. [PMID: 31825352 DOI: 10.17116/hirurgia2019121121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Minimally invasive approach in mitral valve surgery has been applied since the late 1990s. Considerable experience of mini-thoracotomy in cardiac surgery has been gained over this period. Stages of the development of minimally invasive cardiac surgery are reviewed in the article. Features of mitral valve surgery through right-sided mini-thoracotomy are discussed. Surgical outcomes of these procedures are reported considering data of various cardiac surgery centers. Moreover, the authors determined indications and limitations of this technique.
Collapse
Affiliation(s)
- K V Shcherbatyuk
- Clinical Hospital of the Presidential Administration, Moscow, Russia
| | - R N Komarov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O Yu Pidanov
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
4
|
Barac YD, Glower DD. Port-Access Mitral Valve Surgery-An Evolution of Technique. Semin Thorac Cardiovasc Surg 2019; 32:829-837. [PMID: 31518704 DOI: 10.1053/j.semtcvs.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 11/11/2022]
Abstract
Port-access mitral valve surgery has been around since 1995; and many variations upon the technique have been developed. Since 1996, we have performed more than 2500 port-access mitral valve surgeries, and thus gained a substantial experience. The purpose of this document is to describe the current status of port-access mitral surgery at 1 institution, and to share the "know how" and life lessons behind the patient selection and conduct of the operation to accomplish results similar to those achieved from sternotomy mitral valve surgery. While port access started in larger institutions, it can be performed in small centers with the proper guidance of the pearls and pitfalls of this operation, given to young surgeons regarding the right way to start a program.
Collapse
Affiliation(s)
- Yaron D Barac
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Donald D Glower
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
| |
Collapse
|
5
|
|
6
|
Hanada S, Sakamoto H, Swerczek M, Ueda K. Initial experience with percutaneous coronary sinus catheter placement in minimally invasive cardiac surgery in an academic center. BMC Anesthesiol 2016; 16:33. [PMID: 27401491 PMCID: PMC4940684 DOI: 10.1186/s12871-016-0203-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/30/2016] [Indexed: 12/18/2022] Open
Abstract
Background Placement of a percutaneous coronary sinus catheter (CSC) by an anesthesiologist for retrograde cardioplegia in minimally invasive cardiac surgery is relatively safe in experienced hands. However, the popularity of its placement remains limited to a small number of centers due to its perceived complexity and potential complications. Methods We retrospectively reviewed all cardiac cases performed by one surgeon between December 2009 and April 2012. The reviewed cases were divided into two groups: cardiac cases with percutaneous CSC placement (CSC group) and cardiac cases without placement (control group). Anesthesia preparation time (APT) was then compared between the CSC group and control group. In the CSC group, cases were further divided into two groups. One group contained cases with an APT of less than 90 min (success group) and the other contained cases with an APT greater than or equal to 90 min or cases with CSC placement failure (delay/failure group). Patients’ characteristics, type of surgery, and transesophageal echocardiography (TEE) findings were compared between the two groups (success group vs. delay/failure group) to identify variables associated with prolongation of the APT or CSC placement failure. Results Percutaneous CSC placement was required in 83 cases (CSC group). The catheter was successfully placed in 74 of those cases. We experienced one complication, coronary sinus injury after multiple attempts at placing the catheter. The mean APT was 102 ± 31 min in the CSC group (n = 81) and 42 ± 15 min in the control group (n = 285). We could not identify any variables associated with prolongation of the APT or catheter placement failure. Conclusions The success rate of the placement was 89.1 % in our academic center. On average, placing the CSC added approximately one additional hour to the APT. This time is not an accurate representation of true catheter placement time, as it included time for preparation of the CSC, TEE, and fluoroscopy. We experienced one documented complication (coronary sinus injury), which was immediately diagnosed by TEE and fluoroscopy in the operating room. No variables associated with prolongation of APT or CSC placement failure were identified. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0203-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Satoshi Hanada
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hajime Sakamoto
- Department of Anesthesia, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo Prefecture, 674-0063, Japan
| | - Michael Swerczek
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kenichi Ueda
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| |
Collapse
|
7
|
Cancienne JM, Crosen MP, Yarboro SR. Use of a Hybrid Operating Room to Improve Reduction of Syndesmotic Injuries in Ankle Fractures: A Case Report. J Foot Ankle Surg 2015; 55:1052-6. [PMID: 26704537 DOI: 10.1053/j.jfas.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Indexed: 02/03/2023]
Abstract
Ankle fractures are one of the most common orthopedic injuries requiring operative treatment, and approximately 1 in 4 ankle fractures will have an associated distal tibiofibular syndesmosis disruption. Syndesmotic reduction is crucial to restoring ankle function and preventing the development of arthritis. The hybrid operating room provides 3-dimensional intraoperative imaging capabilities that can enable the surgeon to ensure the syndesmosis is appropriately reduced, particularly by comparing it with the contralateral ankle. By confirming the syndesmosis reduction intraoperatively, the risk of a return to the operating room for revision surgery is decreased.
Collapse
Affiliation(s)
- Jourdan M Cancienne
- Resident Physician, Department of Orthopaedics, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Seth R Yarboro
- Assistant Professor, Department of Orthopaedics, University of Virginia School of Medicine, Charlottesville, VA.
| |
Collapse
|
8
|
Richter PH, Yarboro S, Kraus M, Gebhard F. One year orthopaedic trauma experience using an advanced interdisciplinary hybrid operating room. Injury 2015; 46 Suppl 4:S129-34. [PMID: 26542859 DOI: 10.1016/s0020-1383(15)30032-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hybrid operating rooms have been used successfully in several surgical specialties, but no data have been published for orthopaedic trauma. We present our one-year orthopaedic trauma experience using a hybrid operating room, which incorporates 3D fluoroscopic imaging as well as navigation capabilities. Data were compiled for a series of 92 cases performed in an advanced hybrid operating room at the level one trauma center in Ulm, Germany. All patients who had surgery performed using this operating room during the first year were included. Setup time and surgical complications using hybrid operating room were recorded and analysed. The hybrid operating room resulted in no higher rate of complication than expected from the same cases in a conventional operating room. The hybrid room did however allow the surgeon to confidently place implants for orthopaedic trauma cases, and was most advantageous for spine and pelvis cases, both minimally invasive and conventional. Further, appropriate reduction and implant position was confirmed with 3D imaging prior to leaving the operating room and obviated the need for postoperative CT scan. Based on our one-year experience, the hybrid operating room is a useful and safe tool for orthopaedic trauma surgery.
Collapse
Affiliation(s)
| | - Seth Yarboro
- University of Virginia; Charlottesville, Virginia, United States
| | - Michael Kraus
- Donau-Ries Hospital Donauwörth; Donauwoerth, Germany
| | | |
Collapse
|
9
|
Nishi H, Miyata H, Motomura N, Toda K, Miyagawa S, Sawa Y, Takamoto S. Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. Surg Today 2015; 45:1144-52. [DOI: 10.1007/s00595-015-1210-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/28/2015] [Indexed: 11/25/2022]
|
10
|
Tolsma M, Bentala M, Rosseel PMJ, Gerritse BM, Dijkstra HAJ, Mulder PGH, van der Meer NJM. The value of routine chest radiographs after minimally invasive cardiac surgery: an observational cohort study. J Cardiothorac Surg 2014; 9:174. [PMID: 25385274 PMCID: PMC4232684 DOI: 10.1186/s13019-014-0174-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Chest radiographs (CXRs) are obtained frequently in postoperative cardiac surgery patients. The diagnostic and therapeutic efficacy of routine CXRs is known to be low and the discussion regarding the safety of abandoning these CXRs after cardiac surgery is still ongoing. We investigated the value of routine CXRs directly after minimally invasive cardiac surgery. Methods We prospectively included all patients who underwent minimally invasive cardiac surgery by port access, ministernotomy or bilateral video-assisted thoracoscopy (VATS) in the year 2012. A direct postoperative CXR was performed on all patients at ICU arrival. All CXR findings were noted, including whether they led to an intervention or not. The results were compared to the postoperative CXR results in patients who underwent conventional cardiac surgery by full median sternotomy over the same period. Main results A total of 249 consecutive patients were included. Most of these patients underwent valve surgery, rhythm surgery or a combination of both. The diagnostic efficacy for minor findings was highest in the port access and bilateral VATS groups (56% and 63% versus 28% and 45%) (p < 0.005). The diagnostic efficacy for major findings was also higher in these groups (8.9% and 11% versus 4.3% and 3.8%) (p = 0.010). The need for an intervention was most common after minimally invasive surgery by port access, although this difference was not statistically significant (p = 0.056). Conclusions The diagnostic efficacy of routine CXRs performed after minimally invasive cardiac surgery by port access or bilateral VATS is higher than the efficacy of CXRs performed after conventional cardiac surgery. A routine CXR after these procedures should still be considered.
Collapse
Affiliation(s)
- Martijn Tolsma
- Department of Anesthesiology & Intensive Care, Isala Klinieken, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands.
| | - Mohamed Bentala
- Department of Cardiothoracic Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Peter M J Rosseel
- Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Bastiaan M Gerritse
- Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Homme A J Dijkstra
- Department of Radiology, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Paul G H Mulder
- Amphia Hospital, Amphia Academy, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Nardo J M van der Meer
- Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. .,TiasNimbas Business School, Tilburg University, Warandelaan 2, 5037, AB, Tilburg, The Netherlands.
| |
Collapse
|
11
|
Englberger L, Carrel TP, Doss M, Sadowski J, Bartus K, Eckstein FF, Asch FM, Martens S. Clinical performance of a sutureless aortic bioprosthesis: Five-year results of the 3f Enable long-term follow-up study. J Thorac Cardiovasc Surg 2014; 148:1681-7. [DOI: 10.1016/j.jtcvs.2014.03.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
|
12
|
Goldstone AB, Joseph Woo Y. Minimally Invasive Surgical Treatment of Valvular Heart Disease. Semin Thorac Cardiovasc Surg 2014; 26:36-43. [DOI: 10.1053/j.semtcvs.2014.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/11/2022]
|