General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study – Miles – 2016 – Anaesthesia – Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1111/anae.13522/full?platform=hootsuite
Updated: Feb 24, 2017: http://apsf.org/newsletters/html/2017/Feb/10_TAVRsafety.htm

Left atrial occlusion devices

Our hospital is starting to do more left atrial occlusion devices for people who have afib and aren’t able to tolerate blood thinners. Currently, two types are offered by our cardiologists: Watchman procedure (endocardial) vs Lariat procedure (epicardial).

Lariat

It look and acts similar to a lariat or lasso.  An external guide wire with a magnet at its tip is introduced outside the heart towards the left atrial appendage (LAA). Another wire with a magnet at its tip is introduced from a groin vein and it traverses the interatrial septum to sit at the most distal point inside the LAA. The magnets “connect” and the lariat is introduced along the external guide wire and essentially lassos the LAA.

Lariat procedure
Watchman

A large occlusion device is inserted via a groin vein and traverses the interatrial septum into the proximal (base or largest opening) left atrial appendage. The device gets deployed and successfully occludes the LAA.

Watchman

PPT on Watchman from Boston Scientific

Is one better than the other?

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications.  Pillarisetti J, et al. Heart Rhythm. 2015.

CONCLUSION: The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

Anesthesia

For these cases, we typically have a good flowing peripheral IV and intubate these patients for general anesthesia. There’s a fair amount of TEE required for placement and verification of correct positioning of the device. Both procedures require transseptal access. Watch for hypotension as there is a risk for pericardial effusion.

TEE for Lariat

TEE for Lariat


TEE for Watchman

Watchman TEE

Echo Essentials for Endoluminal LAA Closure: April 2014 Cardiac Interventions Today

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation: J Vis Exp. 2012; (60): 3671

Anesthesia and Transesophageal Echocardiography for WATCHMAN Device Implantation: December 2016Volume 30, Issue 6, Pages 1685–1692.

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From JACC: Cardiovascular Interventions
PDF Article

Percutaneous Left Atrial Appendage Closure
Procedural Techniques and Outcomes

3D Echo inside the Cath Lab – A must in LAA Closure. London, 2016.

ECHONOMY:Tools for Echocardiographic Calculations

YouTube: LEFT ATRIAL APPENDAGE CLOSURE PROCEDURE : Role of Transesophageal Echocardiography

YouTube: TCTAP 2015 SHD Live Case Session: LAA Closure

YouTube: How to image the inter-atrial septum using 3D-TEE “RATLe-90 maneuver”

YouTube: TOE in LA Appendage Assessment by Jason Sharp

 

Minimally invasive mitral valve surgery from an anesthesiologist’s perspective. #cardiac #mitral #tee #minimallyinvasive #robot #anesthesia #meded

Surgically, more and more cases are performed through tiny incisions for minimal scarring.  Don’t let that underestimate the size of the procedure.  For example, mitral valve surgery is still a common procedure that involves a sternotomy (“cracking the chest”) and stopping the heart — it’s a big procedure.  However, surgeons have become adept at making smaller incisions while still undergoing the big procedure.

Innovations; 2011: Vol 6, No. 2.  Minimally invasive vs. Conventional open mitral valve surgery: A meta-analysis and systematic review.

Robotic mitral valve repair: anatomic considerations

Journal of Heart Valve Disease: August 2006. 2D Echo measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair

Annals of Cardiothoracic Surgery: 2013;2(6): 796-802. Value of TEE guidance in minimally invasive mitral valve surgery.

Multimedia-Manual of Cardiothoracic Surgery: Vol 2009; Issue 0122. Minimally invasive mitral valve surgery via right minithoracotomy

Cardiac Anesthesia: Principles and Clinical Practice; Chapter 25: Anesthesia for minimally invasive cardiac surgery.

Mitral Valve Repair Center: Post-Repair TEE Assessment.

Medtronic: Echo and surgical techniques for retrograde cardioplegia-coronary sinus cannulation during minimally invasive cardiac valve surgery.

OA Anaesthetics; 2014 Feb 25;2(1):3. Anaesthetics considerations for robotic-assisted cardiac surgery.

A modified anaesthesia protocol for patients undergoing minimally invasive cardiac surgery by thoracotomy – a single center experience.

HSR Proceedings in Intensive Care and Cardiovascular Anesthesia; 2013. Current concepts for minimally invasive mitral valve repair.

2014 Clinical vignette from the surgical prospective

Chauhan S, Sukesan S. Anesthesia for robotic cardiac surgery: An amalgam of technology and skill. Ann Card Anaesth [serial online] 2010 [cited 2016 Apr 12];13:169-75. Available from: http://www.annals.in/text.asp?2010/13/2/169/62947

2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 2,000 times in 2015. If it were a cable car, it would take about 33 trips to carry that many people.

Click here to see the complete report.