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Related Concept Videos

Cardiac Catheterization IV: Nursing Management01:26

Cardiac Catheterization IV: Nursing Management

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Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Cardiac Catheterization III: Left Heart Catheterization01:24

Cardiac Catheterization III: Left Heart Catheterization

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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Cardiac Catheterization I: Pre-Procedure Overview01:28

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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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General Anesthesia: Overview01:24

General Anesthesia: Overview

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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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Aneurysm IV: Nursing Management01:22

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Anesthetic Considerations for Minimally Invasive, Off-Pump, HeartMate III Implantation.

Wendy K Bernstein1, Julie Wyrobek1, Courtney Vidovich2

  • 1Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Journal of Cardiothoracic and Vascular Anesthesia
|February 7, 2022
PubMed
Summary

This study shows that an anesthetic protocol for minimally invasive Heartmate III (HM3) implantation is safe and feasible. The off-pump approach via bilateral minithoracotomies offers a viable alternative for patients needing mechanical support.

Keywords:
adult cardiacanesthetic managementcardiac anesthesiaminimally invasive surgeryoff bypassventricular assist devices

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Area of Science:

  • Cardiac Surgery
  • Anesthesiology
  • Mechanical Circulatory Support

Background:

  • Minimally invasive Heartmate III (HM3) left ventricular assist device (LVAD) implantation is an evolving surgical technique.
  • Anesthetic management for off-pump HM3 implantation, especially in patients with prior mechanical support, requires specific protocols.
  • Traditional sternotomy approaches carry risks, prompting interest in sternal-sparing alternatives.

Purpose of the Study:

  • To develop and evaluate an anesthetic protocol for off-pump HM3 implantation using bilateral minithoracotomies.
  • To assess the safety and feasibility of this minimally invasive approach in patients with existing mechanical support.

Main Methods:

  • Retrospective study of 8 consecutive patients undergoing off-pump HM3 implantation.
  • Utilized bilateral minithoracotomies with a standardized anesthetic management protocol.
  • Single-institution study at the University of Rochester Medical Center.

Main Results:

  • Median time to extubation was 19.7 hours; median ICU length of stay was 6.5 days.
  • 88% survival to discharge; 63% of patients were free from postoperative complications.
  • No patients required a right ventricular assist device; 50% needed transfusions within 24 hours.

Conclusions:

  • Anesthetic management for off-pump HM3 implantation via bilateral minithoracotomies is safe and feasible.
  • This sternal-sparing technique is a viable alternative for patients with existing mechanical support.
  • Further research can validate these findings in larger patient cohorts.