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Chen T, Hayward G, Apruzzese P, Maslow A. Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view. BMC Anesthesiol 2022; 22:326. [PMID: 36280815 PMCID: PMC9590129 DOI: 10.1186/s12871-022-01873-5] [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] [Received: 05/11/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views. Methods After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar’s Exact test. Results Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula. Conclusions Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited.
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Affiliation(s)
- Tzonghuei Chen
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA ,East Greenwich, USA
| | - Geoffrey Hayward
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
| | - Patricia Apruzzese
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
| | - Andrew Maslow
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
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Bouchez S, De Somer F. The evolving role of the modern perfusionist: insights from transesophageal echocardiography. Perfusion 2020; 36:222-232. [PMID: 32729372 DOI: 10.1177/0267659120944094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transesophageal echocardiography is a relatively non-invasive, mobile, safe imaging technique that is ideal for providing real-time information on cardiac anatomy and function during heart surgery. The technology has evolved from two-dimensional to real-time three-dimensional imaging during cardiac procedures, which has significantly benefited preoperative planning, intraoperative guidance, evaluation, and postoperative follow-up. Transesophageal echocardiography may serve the clinical perfusionist by providing imaging guidance for identifying potential problems before cardiopulmonary bypass, guiding the proper placement of cannulas, monitoring cardiac performance on cardiopulmonary bypass, and providing useful feedback during weaning from cardiopulmonary bypass. Although the perfusionist should be able to understand all echocardiographic images and measurements in depth, perfusion-related echocardiographic information can or should be used to optimize the clinical practice of the modern perfusionist. Vice versa, whenever the perfusionist suspects a problem, the surgical team including the sonographer should verify this "clinical treat" by echocardiography whenever possible.
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Affiliation(s)
- Stefaan Bouchez
- Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Filip De Somer
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
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Fitzgerald MM, Bhatt HV, Schuessler ME, Guy TS, Ivascu NS, Evans AS, Ramakrishna H. Robotic Cardiac Surgery Part I: Anesthetic Considerations in Totally Endoscopic Robotic Cardiac Surgery (TERCS). J Cardiothorac Vasc Anesth 2020; 34:267-277. [DOI: 10.1053/j.jvca.2019.02.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/11/2022]
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van der Merwe J, Van Praet F, Stockman B, Degrieck I, Vermeulen Y, Casselman F. Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery. Eur J Cardiothorac Surg 2019; 54:288-293. [PMID: 29462272 DOI: 10.1093/ejcts/ezy027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/10/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study reports the factors that contribute to sternotomy conversions (SCs) and adverse intraoperative events in minimally invasive aortic valve surgery (MI-AVS) and minimally invasive Endoscopic Port Access™ atrioventricular valve surgery (MI-PAS). METHODS In total, 3780 consecutive patients with either aortic valve disease or atrioventricular valve disease underwent minimally invasive valve surgery (MIVS) at our institution between 1 February 1997 and 31 March 2016. MI-AVS was performed in 908 patients (mean age 69.2 ± 11.3 years, 45.2% women, 6.2% redo cardiac surgery) and MI-PAS in 2872 patients (mean age 64.1 ± 13.3 years, 46.7% women, 12.2% redo cardiac surgery). RESULTS A cumulative total of 4415 MIVS procedures (MI-AVS = 908, MI-PAS = 3507) included 1537 valve replacements (MI-AVS = 896, MI-PAS = 641) and 2878 isolated or combined valve repairs (MI-AVS = 12, MI-PAS = 2866). SC was required in 3.0% (n = 114 of 3780) of MIVS patients, which occurred in 3.1% (n = 28 of 908) of MI-AVS patients and 3.0% (n = 86 of 2872) of MI-PAS patients, respectively. Reasons for SC in MI-AVS included inadequate visualization (n = 4, 0.4%) and arterial cannulation difficulty (n = 7, 0.8%). For MI-PAS, SC was required in 54 (2.5%) isolated mitral valve procedures (n = 2183). Factors that contributed to SC in MI-PAS included lung adhesions (n = 35, 1.2%), inadequate visualization (n = 2, 0.1%), ventricular bleeding (n = 3, 0.1%) and atrioventricular dehiscence (n = 5, 0.2%). Neurological deficit occurred in 1 (0.1%) and 3 (3.5%) MI-AVS and MI-PAS conversions, respectively. No operative or 30-day mortalities were observed in MI-AVS conversions (n = 28). The 30-day mortality associated with SC in MI-PAS (n = 86) was 10.5% (n = 9). CONCLUSIONS MIVS is increasingly being recognized as the 'gold-standard' for surgical valve interventions in the context of rapidly expanding catheter-based technology and increasing patient expectations. Surgeons need to be aware of factors that contribute to SC and adverse intraoperative outcomes to ensure that patients enjoy the maximum potential benefit of MIVS and to apply effective risk reduction strategies that encourage safer and sustainable MIVS programmes.
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Affiliation(s)
- Johan van der Merwe
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Yvette Vermeulen
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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van der Merwe J, Casselman F, Van Praet F. Endoscopic Port Access TM left ventricle outflow tract resection and atrioventricular valve surgery. J Vis Surg 2018; 4:100. [PMID: 29963389 DOI: 10.21037/jovs.2018.05.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/21/2018] [Indexed: 11/06/2022]
Abstract
The continuous evolution in robotic-, endoscopic- and trans-catheter cardiac interventions resulted in innovative techniques that simultaneously address left ventricular outflow tract obstruction (LVOTO) and concomitant atrioventricular valve (AVV) pathology in the context of hypertrophic obstructive cardiomyopathy (HOCM). We present our brief report of 13 consecutive HOCM patients with concomitant AVV disease, who underwent endoscopic left ventricular septal myomectomy (LVSM) and AVV surgery by Endoscopic Port AccessTM Surgery (EPAS) between March 1st 2010 and October 31st 2015. Our EPAS technique in the context of HOCM utilizes peripheral cardiopulmonary bypass, endo-aortic balloon occlusion and a 4-cm right antero-lateral thoracic working port. Access to the LVOTO is obtained by detaching the anterior mitral valve (MV) leaflet from the annulus. Controlled sharp LVSM is then performed from the aortic leaflet base to the papillary muscles. Subsequent routine AVV surgery is performed using long shafted instruments. There were no sternotomy conversions, LVSM complications or 30-day mortalities. The mean length of hospitalization was 17.7±18.1 days. Long-term clinical and echocardiographic analysis of 645.7 patient-months (n=13, 100.0% complete) identified two late mortalities, which were not procedure-, HOCM- or AVV-related. All patients (n=13, 100.0%), including the late mortalities, had significant improvement in their quality of life, a 100% long-term freedom from re-intervention and no residual peak instantaneous LVOTO gradients more than 15 mmHg. This brief report emphasises that simultaneous LVSM and concomitant AVV surgery by EPAS can safely be performed in experienced centres with favourable long-term outcomes.
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Affiliation(s)
- Johan van der Merwe
- Department of Cardiovascular and Thoracic Surgery, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, Onze Lieve Vrouw Clinic, Aalst, Belgium
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Labriola C, Greco F, Braccio M, Paolo Dambruoso P, Labriola G, Paparella D. Percutaneous Coronary Sinus Catheterization With the ProPlege Catheter Under Transesophageal Echocardiography and Pressure Guidance. J Cardiothorac Vasc Anesth 2015; 29:598-604. [DOI: 10.1053/j.jvca.2015.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Indexed: 11/11/2022]
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7
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Abstract
The transition of mitral valve surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve. The use of telemanipulative robotic arms with near 3-dimensional valve visualization has allowed for near complete endoscopic robotic-assisted mitral valve surgery, providing increased patient satisfaction and cosmesis. Studies have shown rapid recovery times without sacrificing perioperative safety or the durability of surgical repair. Although a steep learning curve exists as well as high fixed and disposable costs, continued technological development fueled by increasing patient demand may allow for further expansion in the use of robotic-assisted minimal invasive surgery.
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Affiliation(s)
- William Vernick
- Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University Hosptial of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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The Swan-Ganz catheter as a teaching tool for the anesthesiologist learning minimally invasive cardiac surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:204-7. [PMID: 22885463 DOI: 10.1097/imi.0b013e31826521fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform minimally invasive cardiac surgery through the smallest possible wound and with the least number of incisions in the heart or aorta, the necessary cannulations to undergo cardiopulmonary bypass must be done through peripheral vessels. A difficult skill to learn for the cardiac anesthesiologist is how to safely and efficiently position the coronary sinus catheter (Endoplege; Edwards Lifesciences LLC, Irvine, CA USA) required for retrograde cardioplegia administration. METHODS In patients in whom a Swan-Ganz catheter was inserted as part of the operative management strategy for non-minimally invasive heart surgery, we have been using it as a training tool to learn how to visualize and manipulate right-sided catheters under transesophageal echocardiography. We developed this teaching technique to help hone some of the necessary skills needed to place the Endoplege catheter for minimally invasive cardiac surgery. Manipulation was done with the goal of visualizing the catheter and guiding it into the coronary sinus. For a 4-month period, anesthesia records were retrospectively reviewed. RESULTS Fifteen patients, for a total of 19 catheter manipulations, were found in whom we had documented the use of the Swan-Ganz catheter and details about the insertion as a training tool. The coronary sinus and the catheter were visualized 100% of the time. The Swan-Ganz catheter was successfully inserted into the coronary sinus in 17 of 19 catheter manipulations. CONCLUSIONS The Swan-Ganz catheter can be used as a training tool to develop some of the necessary skills to place catheters into the coronary sinus with transesophageal echocardiography guidance.
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9
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Cannulation of the middle cardiac vein during MICS. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:62-4. [PMID: 22576038 DOI: 10.1097/imi.0b013e318254dfb6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary sinus cannulation for retrograde cardioplegia administration during cardiac surgery is common practice. Several of the cannulas that are placed by the cardiac surgeon on open procedures are now placed by the cardiac anesthesiologist during minimally invasive cardiac surgery, including the coronary sinus catheter. The understanding of the cardiac venous anatomy is very important during coronary sinus catheter placement. We present a case where a percutaneously placed coronary sinus catheter was inadvertently placed into the middle cardiac vein but detected with the use of fluoroscopy.
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10
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Pantin EJ, Kraidin JL, Ginsberg SH, Denny JT, Anderson MB, Solina AR. The Swan-Ganz Catheter as a Teaching Tool for the Anesthesiologist Learning Minimally Invasive Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Enrique J. Pantin
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Jonathan L. Kraidin
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Steven H. Ginsberg
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - John T. Denny
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Mark B. Anderson
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Alann R. Solina
- Division of Cardiac Anesthesia, Department of Anesthesia and Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
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Vernick WJ, Woo JY. Anesthetic considerations during minimally invasive mitral valve surgery. Semin Cardiothorac Vasc Anesth 2012; 16:11-24. [PMID: 22361820 DOI: 10.1177/1089253211434591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in instruments and visualization tools as well as circulatory systems for cardiopulmonary bypass during the late 1990s have stimulated widespread adoption of minimally invasive mitral valve surgery (MIMVS). Today, MIMVS is the standard approach for many surgeons and institutions. There are multiple benefits of MIMVS. Patient satisfaction and improved cosmesis are important. Additionally, studies have consistently shown faster recovery times and less associated pain with MIMVS. Statistically significant improvement in bleeding, transfusion, incidence of atrial fibrillation, and time to resumption of normal activities with MIMVS has also been shown when comparing MIMVS with conventional mitral surgery. Most important, these benefits have been achieved without sacrificing perioperative safety or durability of surgical repair. Although a steep learning curve still exists given the high level of case complexity, continued development fueled by increasing patient demand may allow for even further expansion in the use of minimal invasive techniques.
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Affiliation(s)
- William J Vernick
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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12
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Pantin EJ, Kraidin JL, Ginsberg SH, Denny JT, Solina AR. Cannulation of the Middle Cardiac Vein during MICS. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Enrique J. Pantin
- Department of Anesthesia, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Jonathan L. Kraidin
- Department of Anesthesia, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Steven H. Ginsberg
- Department of Anesthesia, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - John T. Denny
- Department of Anesthesia, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
| | - Alann R. Solina
- Department of Anesthesia, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
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13
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Kraidin J, Ginsberg S, Pantin E, Veksler B, Anderson M, Fisch D, Solina A. Left atrial mass during a minimally invasive thoracic mitral valve replacement. J Cardiothorac Vasc Anesth 2010; 25:376-7. [PMID: 20573521 DOI: 10.1053/j.jvca.2010.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Kraidin
- Department of Anesthesia, Robert Wood University Hospital, New Brunswick, NJ 08901, USA.
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Abstract
The monitoring of cardiovascular function is an indispensable element in anaesthesia. A thorough understanding of pathophysiology in various disease states allows optimal balancing of the invasiveness and completeness of haemodynamic monitoring. The prevention of both intraoperative and postoperative complications is therefore a primary goal.
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Affiliation(s)
- J I Poelaert
- Cardiac Anaesthesia and Postoperative Cardiac Surgical Intensive Care Unit, Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, B9000 Gent, Belgium.
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Hunsaker RP. Intraoperative transesophageal echocardiography: standard monitor and diagnostic instrument for difficult situations? J Clin Anesth 2005; 17:155-7. [PMID: 15896578 DOI: 10.1016/j.jclinane.2005.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 02/23/2005] [Indexed: 11/20/2022]
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Casselman FP, Van Slycke S, Dom H, Lambrechts DL, Vermeulen Y, Vanermen H. Endoscopic mitral valve repair: feasible, reproducible, and durable. J Thorac Cardiovasc Surg 2003; 125:273-82. [PMID: 12579095 DOI: 10.1067/mtc.2003.19] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to document the feasibility, safety, and effectiveness of performing mitral valve repair using a totally endoscopic approach. METHODS Between February 1997 and October 1, 2001, 187 patients underwent totally endoscopic mitral valve repair at our institution. The mean age was 60.7 +/- 13.1 years, and 62% were male. Median preoperative functional class and degree of mitral regurgitation were II and 4, respectively. Data collection included an institutional protocol assessing procedure-related pain, cosmesis, and functional recovery. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19 +/- 15.2 months and was 100% complete. RESULTS Associated atrial procedures were performed in 9.1% (n = 17) of the patients. Two patients required intraoperative conversion to sternotomy. Thoracoscopic re-evaluation for suspected bleeding (n = 19) was part of our aggressive postoperative management. One patient required sternotomy for control of bleeding. Hospital mortality included 1 (0.5%) patient and was not technology related. There were 1 early and 6 late reoperations, 4 of which were due to endocarditis. No risk factors for repair failure could be detected. Freedom from mitral valve reoperation at 4 years was 93.3% +/- 2.6%. The median degree of mitral regurgitation at follow-up was 0. Ninety-three percent of the patients were highly satisfied with either no or mild postoperative pain, and 98.4% believed they had an aesthetically pleasing scar. CONCLUSIONS Totally endoscopic mitral valve repair can be done safely with excellent results and a high degree of patient satisfaction. It is now our exclusive approach for isolated atrioventricular valve disease.
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Affiliation(s)
- Filip P Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
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Coddens J, Callebaut F, Hendrickx J, Deloof T, Grossi E, Mangano CT. Case 5--2001. Port-access cardiac surgery and aortic dissection: the role of transesophageal echocardiography. J Cardiothorac Vasc Anesth 2001; 15:251-8. [PMID: 11312490 DOI: 10.1053/jcan.2001.22012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Coddens
- Department of Anesthesia and Intensive Care Medicine, Onze Lieve Vrouw Clinics, Aalst, Belgium.
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Abstract
Transoesophageal echocardiography has proved to be a valuable monitor of global and regional ventricular function in the perioperative period. In addition, it is increasingly used by anaesthetists as a diagnostic tool in patients with heart disease. During the past year, important steps towards quality assurance and the standardization of perioperative echocardiography were undertaken, and our understanding of the perioperative cardiovascular structure and function improved.
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Affiliation(s)
- K Skarvan
- Department of Anaesthesia, University of Basel, Switzerland.
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