RESUMO
Unilateral pulmonary edema (UPE) is an uncommon yet potentially life-threatening complication of minimally invasive cardiac surgery (MICS). Most frequently described after robotically assisted mitral valve (MV) repair, it is characterized by right lung edema, hypoxemia, hypercapnia, pulmonary hypertension, and hemodynamic instability beginning minutes-to-hours after separation from cardiopulmonary bypass (CPB). The authors describe a severe case with refractory hypoxemia requiring veno-venous (VV) extracorporeal membrane oxygenation (ECMO) after robotically assisted MV repair.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Oxigenação por Membrana Extracorpórea , Edema Pulmonar , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversosAssuntos
Septo Interatrial , Insuficiência da Valva Mitral , Septo Interatrial/diagnóstico por imagem , Ponte Cardiopulmonar/efeitos adversos , Ecocardiografia Transesofagiana , Humanos , Doença Iatrogênica , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Choque Cardiogênico/diagnóstico por imagem , Choque Cardiogênico/etiologiaRESUMO
In less than 15 years, transcatheter aortic valve replacement (TAVR) has progressed from a procedure of last resort in patients at prohibitively high perioperative risk for major morbidity and mortality from surgical valve replacement to a viable alternative option to surgery in most patients with native (non-bicuspid) aortic valve stenosis. The number of medical centers offering TAVR has rapidly proliferated. There is mounting evidence that there are variations in patient outcomes associated with the yearly number of TAVR cases performed at each respective center. This review outlines the evolution of TAVR indications, common complications, the current literature addressing the association between procedural volumes and patient outcomes in TAVR, and offers a synopsis of risk factor assessment for patients considered for TAVR.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoAssuntos
Cateterismo Cardíaco/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Cateterismo Cardíaco/normas , Ponte de Artéria Coronária/normas , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Humanos , Revascularização Miocárdica/normas , Intervenção Coronária Percutânea/normas , Resultado do TratamentoRESUMO
Malignant hyperthermia is a potentially life-threatening hypermetabolic disorder, often induced by exposure to volatile anesthetics and succinylcholine. There are few reports of malignant hyperthermia during cardiopulmonary bypass. Here the authors review available literature including case reports of malignant hyperthermia and cardiopulmonary bypass and discuss the potential implications of malignant hyperthermia diagnosis and management as it applies to cardiac surgery.
Assuntos
Anestésicos Inalatórios/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Hipertermia Maligna/sangue , Hipertermia Maligna/diagnóstico , Gasometria/métodos , Ponte Cardiopulmonar/métodos , Humanos , Hipertermia Maligna/etiologia , Resultado do TratamentoAssuntos
Fibrilação Atrial/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Profilaxia Pré-Exposição/métodos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Fibrilação Atrial/etiologia , Humanos , Complicações Pós-Operatórias/etiologia , Profilaxia Pré-Exposição/tendências , Procedimentos Cirúrgicos Torácicos/tendênciasRESUMO
BACKGROUND: Rigid video laryngoscopes are popular alternatives to direct laryngoscopy for intubation, but further large scale prospective studies comparing these devices to direct laryngoscopy in routine anesthesiology practice are needed. We hypothesized that the first pass success rate with one particular video laryngoscope, the GlideScope, would be higher than the success rate with direct laryngoscopy. METHODS: 3831 total intubation attempts were tracked in an observational study comparing first-pass success rate using a Macintosh or Miller-style laryngoscope with the GlideScope. Propensity scoring was then used to select 626 subjects matched between the two groups based on their morphologic traits. RESULTS: Comparing the GlideScope and direct laryngoscopy groups suggested that intubation would be more difficult in the GlideScope group based on the Mallampati class, cervical range of motion, mouth opening, dentition, weight, and past intubation history. Thus, a propensity score based on these factors was used to balance the groups into two 313 patient cohorts. Direct laryngoscopy was successful in 80.8% on the first-pass intubation attempt, while the GlideScope was successful in 93.6% (p <0.001; risk difference of 0.128 with a 95% CI of 0.0771 - 0.181). CONCLUSION: A greater first-attempt success rate was found when using the GlideScope versus direct laryngoscopy. In addition, the GlideScope was found to be 99% successful for intubation after initial failure of direct laryngoscopy, helping to reduce the incidence of failed intubation.