The heart surgery forum
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The heart surgery forum · Feb 2020
Review Case ReportsTransseptal Approach for Mitral Valve Replacement in Dextrocardia with Situs Inversus Totalis: A Case Report and Review of the Literature.
We consider mitral valve disease requiring surgery in a patient with dextrocardia and situs inversus totalis to be an exceptional finding. The transseptal approach for mitral valve surgery in dextrocardia represents a technical challenge owing to its anatomic particulars. We present the case of a 56-year-old female patient who had been diagnosed with situs inversus totalis in childhood and with chronic atrial fibrillation in adulthood and was under oral anticoagulant treatment. ⋯ Contrast chest computed tomography (CT) and preoperative abdominal CT showed both dextrocardia and situs inversus totalis, with normal continuity of the inferior vena cava. Biatrial cannulation was performed with the surgeon standing on the right side of the patient, and mitral valve replacement using a transseptal approach was performed with the surgeon standing on the left side of the patient. In this case report, we emphasize the rarity of mitral valve disease in a patient with dextrocardia and the inherent potential difficulty that can appear in this particular anatomic condition.
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The heart surgery forum · Dec 2018
ReviewThe Disparate Effects of Epinephrine and Norepinephrine on Hyperglycemia in Cardiovascular Surgery.
Hyperglycemia is a metabolic derangement that frequently develops after cardiovascular surgery. The perioperative administration of inotropic and vasoactive agents, such as epinephrine and norepinephrine, are common in the management of cardiac surgery patients and are known to contribute to the development of postoperative hyperglycemia. ⋯ This literature review outlines the mechanisms by which epinephrine and norepinephrine alter glucose homeostasis, while highlighting the significant differences in their effects on hepatic glucose mobilization and peripheral glucose utilization. This review suggests that the use of epinephrine exacerbates postoperative hyperglycemia to a greater degree than does norepinephrine.
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The heart surgery forum · Nov 2018
ReviewUse of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience.
During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular complications, and increased risk of infection. ⋯ In addition to AP and CO, the system provides up-to-date information on stroke volume (SV), stroke volume variation (SVV), and systemic vascular resistance, which can be useful in aiding decision-making and provide better postoperative outcomes, such as shorter length of stay (LOS), decreased postoperative infection, decreased postoperative arrhythmia, decreased postoperative renal failure, decreased postoperative congestive heart failure (CHF), and decreased readmission. Additionally, the simplicity of the system setup has translated into a time saving of up to 3 hours per day, allowing one team to perform an additional 2 to 3 valve interventions without moving rooms. Moving forward, a formal study comparing patient outcomes and cost-effectiveness between invasive and noninvasive hemodynamic monitoring techniques in valve replacement would be insightful.
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The heart surgery forum · Dec 2017
ReviewExtracorporeal Membrane Oxygenation (ECMO): An Option for Cardiac Reccovery from Advanced Cardiogenic Shock.
Mechanical circulatory support can prevent multi-organ failure and death in patients with advanced cardiogenic shock. Here we describe our experience using extracorporeal membrane oxygenation (ECMO) for treatment of advanced cardiogenic shock which has been used by our team for daily routine care in more than 200 patients during the last five years at the Penn State Medical Center. Venoarterial (VA) ECMO has been used as a viable therapeutic option for advanced cardiogenic shock as a bridge to recovery (BTR) or bridge to next decision (BTD). Our group performed a retrospective review of data from 155 patients from our single center cohort treated with VA ECMO for advanced cardiogenic shock. After successful ECMO treatment, the one year survival rate of patients with ischemic heart disease was 73.7 %, and the one year survival for patients with non-ischemic heart disease was 75%.
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Vasoplegic syndrome is a form of vasodilatory shock that occurs frequently in patients who undergo cardiac surgery requiring cardiopulmonary bypass (CBP). Treatment often demands high doses of vasopressors over sustained periods for hypotension that can be refractory to standard vasoactive medications. ⋯ Methylene blue (MB) has become a popular therapy for cardiac vasoplegia despite a paucity of prospective data to direct its use. Therefore, the aim of this study was to review available data regarding mechanisms, dosing strategies, and side effects of MB, with a focus on its applications for vasoplegia in cardiac surgery.