Use of a Miniaturized Transesophageal Echocardiographic Probe in the Intensive Care Unit for Diagnosis and Treatment of a Hemodynamically Unstable Patient After Aortic Valve Replacement

2012 ◽  
Vol 26 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Chad E. Wagner ◽  
Julian S. Bick ◽  
Benjamin H. Webster ◽  
John H. Selby ◽  
John G. Byrne
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Diagnosis And Treatment ◽  
Unstable Patient

Acute Heart Failure at the Time of Transcatheter Aortic Valve Replacement Does not Increase Mortality

2018 ◽  
Vol 13 (1) ◽  
pp. 47-50 ◽  
Author(s):  
William T. Burke ◽  
Jaimin R. Trivedi ◽  
Michael P. Flaherty ◽  
Kendra J. Grubb
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Natriuretic Peptide ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Objective Patients presenting for transcatheter aortic valve replacement are often in acute on chronic heart failure, as indicated by elevated N-terminal pro-B-type natriuretic peptide. Many believe that elevated N-terminal pro-B-type natriuretic peptide is an indication to treat medically, reserving surgery until the patient is medically optimized. Methods A single-center transcatheter aortic valve replacement database was queried from December 2015 to November 2016 to identify patients undergoing transcatheter aortic valve replacement. Patients were divided into two cohorts based on preoperative N-terminal pro-B-type natriuretic peptide level. An analysis was then completed to assess outcomes such as length of intensive care unit stay, total length of stay, discharge to home, major complications, and mortality at 30 days. Results There were 142 patients (median age = 80 years, 44% female) with preoperative N-terminal pro-B-type natriuretic peptide data included (range = 106–73,500 pg/mL). The mean Society of Thoracic Surgeons predicative risk of mortality was 8%, and 46 patients (32%) had N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL. N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL was associated only with increased intensive care unit length of stay of greater than 24 hours (35% vs 9%, P = 0.0001). There was no statistical difference between cohorts with regard to total length of stay of greater than 3 days (24% vs 15%, P = 0.2), discharge to home (74% vs 83%, P = 0.3), major complication, or mortality at 30 days. Conclusions Transcatheter aortic valve replacement is an appropriate and effective treatment for patients with aortic stenosis presenting with high N-terminal pro-B-type natriuretic peptide and acute on chronic heart failure.

Traditional Sternotomy versus Minimally Invasive Aortic Valve Replacement in Patients Stratified by Ejection Fraction

2017 ◽  
Vol 12 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Tom C. Nguyen ◽  
Vinod H. Thourani ◽  
Justin Q. Pham ◽  
Yelin Zhao ◽  
Matthew D. Terwelp ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Short Term ◽  
Postoperative Length ◽  
Sts Score

Objective Low ejection fraction (EF < 40%) portends adverse outcomes in patients undergoing valvular heart surgery. The role of traditional median sternotomy aortic valve replacement (SAVR) compared with minimally invasive aortic valve replacement (MIAVR) in this cohort remains incompletely understood. Methods A multi-institutional retrospective review of 1503 patients who underwent SAVR (n = 815) and MIAVR via right anterior thoracotomy (n = 688) from 2011 to 2014 was performed. Patients were stratified into two groups: EF of less than 40% and EF of 40% or more. In each EF group, SAVR and MIAVR patients were propensity matched by age, sex, body mass index, race, diabetes, hypertension, dyslipidemia, dialysis, cerebrovascular disease, cardiovascular disease, cerebro-vascular accident, peripheral vascular disease, last creatinine level, EF, previous MI and cardiogenic shock, and the Society for Thoracic Surgeons (STS) score. Results Among patients with an EF of 40% or more (377 pairs), patients who underwent MIAVR compared with SAVR had decreased intensive care unit hours (56.8% vs 84.6%, P < 0.001), postoperative length of stay (7.1 vs 7.9 days, P = 0.04), incidence of atrial fibrillation (18.8% vs 38.7%, P < 0.001), bleeding (0.8% vs 3.2%, P = 0.04), and a trend toward decreased 30-day mortality (0.3% vs 1.3%, P = 0.22). The STS scores were largely equivalent in patients undergoing MIAVR compared with SAVR (2.4% vs 2.6%, P = 0.09). In patients with an EF of less than 40% (35 pairs), there was no difference in intensive care unit hours (69% vs 72.6%, P = 0.80), postoperative length of stay (10.3 vs 7.2 days, P = 0.13), 30-day mortality (3.8% vs 0.8%, P = 0.50), or the STS score (3.3% vs 3.2%, P = 0.68). Conclusions Minimally invasive aortic valve replacement in patients with preserved EF was associated with improved short-term outcomes compared with SAVR. In patients with left ventricular dysfunction, short-term outcomes between MIAVR and SAVR are largely equivalent.

Minimally invasive aortic valve replacement reduces atelectasis in cardiac intensive care

2009 ◽  
Vol 11 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Signe Foghsgaard ◽  
Dunia Gazi ◽  
Karen Bach ◽  
Hanne Hansen ◽  
Thomas Andersen Schmidt ◽  
...  
Keyword(s):  
Intensive Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Cardiac Intensive Care

scholarly journals J-Shaped Upper Mini-Sternotomy Versus Full Sternotomy for Aortic Valve Replacement: A Comparative Study

2020 ◽  
Vol 23 (4) ◽  
pp. E411-E415
Author(s):  
Álvaro Borrero ◽  
Tatiana Julieth Samboni ◽  
Natalia Prado ◽  
Diana Cristina Carrillo-Gómez ◽  
German Camilo Giraldo-Gonzalez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Stay ◽  
Medical History ◽  
Valve Replacement ◽  
Clinical Care ◽  
Aortic Surgery ◽  
Lower Percentage ◽  
Intensive Care Stay

Background: This study aims to compare the characteristics between patients who underwent aortic valve replacement (AVR) through a J-shaped upper mini-sternotomy (UMS) and patients who underwent full sternotomy (FS) in the basis of clinical care and hospital outcomes. Methods: A retrospective, cross-sectional study was conducted on adult patients who were subjected to AVR by UMS from 2014 to 2017, compared with a historical control of patients who had undergone UMS by FS from 2011 to 2014. Patients, who received combined valve replacement or aortic surgery, as well as heart valve reinterventions due to endocarditis, were excluded. Sociodemographic characteristics, medical history, hospital and intensive care stay, blood transfusions, complications, and mortality of both procedures were compared. Results: There were 57 patients under UMS and 99 patients under FS included in this study. The median age was 67 years, and 56.77% of the patients were male. No differences were observed in the past medical history and the type of valve implanted between the groups. During surgery, patients under UMS received a lower percentage of red blood cell and platelet transfusions compared with FS. However, UMS had a higher percentage of cryoprecipitate transfusion. Intensive care stay was shorter in UMS compared with FS (three days; interquartile range [IQR], 2–4; and four days; IQR, 2–6, respectively) without differences in overall hospital stay, postoperative complications, in-hospital mortality, and 30-day mortality. Conclusions: The J-shaped upper mini-sternotomy is a feasible surgical technique that does not increase in-hospital or 30-day mortality, neither hospital stay nor infectious complications.

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