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Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation
BACKGROUND: Patients who undergo transapical transcatheter aortic/mitral valve implantation are at higher risk of morbidity and mortality than those undergoing transvascular procedures. In addition, these patients have prolonged intensive care and hospital courses. Fast-track anesthesia could reduce...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411149/ https://www.ncbi.nlm.nih.gov/pubmed/34527324 http://dx.doi.org/10.21037/jtd-21-751 |
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author | Haddad, Ali Szalai, Cynthia van Brakel, Lena Elhmidi, Yacine Arends, Sven Rabis, Marco Pop, Anca Ruhparwar, Arjang Brenner, Thorsten Shehada, Sharaf-Eldin |
author_facet | Haddad, Ali Szalai, Cynthia van Brakel, Lena Elhmidi, Yacine Arends, Sven Rabis, Marco Pop, Anca Ruhparwar, Arjang Brenner, Thorsten Shehada, Sharaf-Eldin |
author_sort | Haddad, Ali |
collection | PubMed |
description | BACKGROUND: Patients who undergo transapical transcatheter aortic/mitral valve implantation are at higher risk of morbidity and mortality than those undergoing transvascular procedures. In addition, these patients have prolonged intensive care and hospital courses. Fast-track anesthesia could reduce perioperative complications and admission stays in such patients. METHODS: This retrospective single-center study, evaluates six high-risk patients undergoing transapical valve implantation between 01/2020 till 01/2021. All patients received a paravertebral block (PVB) as part of a fast-track approach. The airway was secured with a Gastro-double-lumen laryngeal mask which includes one orifice was for ventilation and one for the transesophageal echocardiography probe. Anesthesia was maintained with a volatile anesthetic (Sevoflurane MAC 1%). Immediately post procedure, all patients were awakened and admitted to the intermediate/intensive-care unit. RESULTS: Three patients were females, mean age =71±6 years, patients’ risk profiles were high (mean Log. EuroSCORE-I 22% & STS-PROM 10%). No incidents of re-intubation, atelectasis/pneumonia, low output syndrome, stroke, dialysis, pacemaker implantation or operative mortality were reported. One patient (16.7%) underwent re-exploration for bleeding and developed a wound infection. Postoperative pain scores showed that no patient required additional analgesics after the initial eight hours post procedure. Mean postoperative intermediate/intensive-care stay was 13.8±3.2 hours and patients were mobilized early and discharged to the normal ward. CONCLUSIONS: Fast-track anesthesia using paravertebral-blockade for transcatheter transapical valve replacement in high-risk patients is a possible anesthetic approach. An effective PVB, in addition to a double-lumen laryngeal mask, provide an alternative strategy to conventional general anesthesia. These promising results could encourage further consideration of this approach in similar cardiac surgery patients. |
format | Online Article Text |
id | pubmed-8411149 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-84111492021-09-14 Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation Haddad, Ali Szalai, Cynthia van Brakel, Lena Elhmidi, Yacine Arends, Sven Rabis, Marco Pop, Anca Ruhparwar, Arjang Brenner, Thorsten Shehada, Sharaf-Eldin J Thorac Dis Original Article BACKGROUND: Patients who undergo transapical transcatheter aortic/mitral valve implantation are at higher risk of morbidity and mortality than those undergoing transvascular procedures. In addition, these patients have prolonged intensive care and hospital courses. Fast-track anesthesia could reduce perioperative complications and admission stays in such patients. METHODS: This retrospective single-center study, evaluates six high-risk patients undergoing transapical valve implantation between 01/2020 till 01/2021. All patients received a paravertebral block (PVB) as part of a fast-track approach. The airway was secured with a Gastro-double-lumen laryngeal mask which includes one orifice was for ventilation and one for the transesophageal echocardiography probe. Anesthesia was maintained with a volatile anesthetic (Sevoflurane MAC 1%). Immediately post procedure, all patients were awakened and admitted to the intermediate/intensive-care unit. RESULTS: Three patients were females, mean age =71±6 years, patients’ risk profiles were high (mean Log. EuroSCORE-I 22% & STS-PROM 10%). No incidents of re-intubation, atelectasis/pneumonia, low output syndrome, stroke, dialysis, pacemaker implantation or operative mortality were reported. One patient (16.7%) underwent re-exploration for bleeding and developed a wound infection. Postoperative pain scores showed that no patient required additional analgesics after the initial eight hours post procedure. Mean postoperative intermediate/intensive-care stay was 13.8±3.2 hours and patients were mobilized early and discharged to the normal ward. CONCLUSIONS: Fast-track anesthesia using paravertebral-blockade for transcatheter transapical valve replacement in high-risk patients is a possible anesthetic approach. An effective PVB, in addition to a double-lumen laryngeal mask, provide an alternative strategy to conventional general anesthesia. These promising results could encourage further consideration of this approach in similar cardiac surgery patients. AME Publishing Company 2021-08 /pmc/articles/PMC8411149/ /pubmed/34527324 http://dx.doi.org/10.21037/jtd-21-751 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Haddad, Ali Szalai, Cynthia van Brakel, Lena Elhmidi, Yacine Arends, Sven Rabis, Marco Pop, Anca Ruhparwar, Arjang Brenner, Thorsten Shehada, Sharaf-Eldin Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title | Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title_full | Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title_fullStr | Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title_full_unstemmed | Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title_short | Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
title_sort | fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411149/ https://www.ncbi.nlm.nih.gov/pubmed/34527324 http://dx.doi.org/10.21037/jtd-21-751 |
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