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1.
J Cardiothorac Vasc Anesth ; 36(7): 2022-2030, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34736862

RESUMO

OBJECTIVE: The purpose of this study was to determine the incidence and types of interventions triggered during a drop of baseline near-infraredspectroscopy (NIRS) values in consecutive cardiac surgical patients. DESIGN: A single-center, retrospective observational study. SETTING: A university-affiliated tertiary care center. PARTICIPANTS: Three thousand three hundred two consecutive cardiac surgical patients from October 2016 to August 2017 Interventions: None. MEASUREMENTS AND MAIN RESULTS: Of the 1,972 patients who met the inclusion criteria, 576 (29.2%) patients showed NIRS deviation of -20% from baseline. Interventions performed during the drop of baseline NIRS values were documented in 285 (14.4%) patients, with a total of 391 interventions. Three hundred fifteen (80%) interventions were triggered by a deviation in NIRS and concomitant changes in standard monitoring parameters. Seventy-six (20%) interventions were triggered by NIRS deviation alone, with no concomitant pathologic deviation in standard monitoring. A total of 279 (71%) interventions were performed on patients who had no recommendation for NIRS monitoring by current national guidelines. Out of these, 30 (7.7%) interventions (1.3% of all patients) were performed based on NIRS monitoring alone. The higher risk deviation group had longer intensive care unit and hospital lengths of stays (one and 15 days) and postoperative delirium when compared with the no-deviation group (zero and 13 days) Conclusions: The authors' data suggested that most interventions triggered during the drop of baseline values during routine use of NIRS would have also been triggered by the concomitant changes in standard monitoring parameters. Routine use of NIRS for all cardiac surgical patients still is debatable and needs to be evaluated in a large prospective trial.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Espectroscopia de Luz Próxima ao Infravermelho , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Oxigênio , Estudos Prospectivos , Estudos Retrospectivos , Espectroscopia de Luz Próxima ao Infravermelho/métodos
2.
J Am Soc Echocardiogr ; 34(6): 676-689, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33675944

RESUMO

Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) is a recently developed technique to reduce the risk of ostial coronary obstruction during transcatheter aortic valve replacement. Intraprocedural fluoroscopy and transesophageal echocardiography imaging are used complimentarily to guide the procedure. So far, no structured echocardiographic imaging protocol has been described for this intervention. Based on an experience of more than 50 BASILICA procedures at two different institutions, we present a step-by-step approach for transesophageal echocardiography guidance during BASILICA and highlight anatomical and procedural characteristics from an echocardiographic perspective.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Lacerações , Pectinidae , Substituição da Valva Aórtica Transcateter , Animais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Vasos Coronários , Ecocardiografia Transesofagiana , Fluoroscopia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Doença Iatrogênica/prevenção & controle , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
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