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Dialysis Charges Procedure Charges
Investigation (Before Dialysis)
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| Centre of Excellence |
New technique of aortic valve replacement in dilated aortic annulus with normal dimensions of ascending aorta |
Drs. Shirish M Dhoble, Kshitij Dubey, Rajesh Kukreja, Sushil Jain; Department Of Cardiothoracic and Vascular Surgery; Gagan Shrivastav; Department Of Cardiac Anaesthesiology, Gokuldas Hospital, Indore, M.P. india.
We present our brief experience of six cases that underwent aortic valve replacement with a new and perhaps unrecorded so far technique. All these cases had one common feature of morphology i.c. dilated aortic annulus with normal ascending aorta Size with severe Aortic Regurgitation.
We realized that these patients did not need anything for there aortic root while replacing the valve we preserved the cusps and integrated them with annulus using plicating sutures from annulus to the cusp edges.
We discuss the outcome, anxieties and possible positives out of this procedure. |
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OP - 1173 - thoracic epidural anesthesia in open heart surgery-conscious open heart surgery |
Dhoble, Shirish M Dubey, Kshitij, Kukreja, Rajesh; Jain, Sushil, Indore, India |
| Backgroud |
There are reports of cardiac surgeries, inclusive of open heart surgeries and on and off pump CABGs, performed in Thoracic Epidural Anaesthesia (TEA) alone. We reviewed this literature and took up this approach to accomplish our cardiac surgeries in April 2005. Because of the inherently less invasive nature, excellent need of administering routinely used ionotrops and analgesic agents, significantly increased hemodynamic stability during off-pump CABGs attributed to very specific autonomic changes brought about by thoracic epidural anaesthesia. We present our experience of CABGS, valve replacements, ASDs, valve replacement with CABG, left atrial Myxomas, thymectomy, etc. done under TEA. |
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| Methods |
All adult patients hospitalized for open heart surgery were considered for TEA and were screened for presence of contraindication. Out of about 600 cases, 424 cases were chosen for TEA. TEA catheter was positioned at a level varying from T2 to T6. After initial bolus of 0.5% Bupivacaine, analgesia was maintained with continuous infusion of 0.25% Bupivacaine through epidural catheter, Surgical techniques were improvised to safeguard pleural integrity during sternotomy, while dissecting internal mammary arteries (IMA), while harvesting pericardial patches, and consequent loss
of spontaneous breathing. We also discuss the methods to avoid conversion to General Anesthesia making concessions for spontaneous respiratory movements. |
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| Results |
Over a period of 29 months we attempted TEA in 424 cases. We could successfully conclude the surgery in 266 cases, 93 cases were converted to general anaesthesia while 65 cases were administered general anaesthesia electively. Pneumothorax was the main cause of conversion in our cases apart from various other causes in the remaining. We have noticed a remarkable reduction in intra-operative and post-operative strength and duration of ionotropic agents required, analgesics and insulin. We also noticed early gut motility and early mobilization in these cases. We are currently in the middle of a study which will document these areas in a more statistically correct manner. |
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| Conclusions |
Initial reports of successful use of this technique not only in CABG but also to other cardiac surgeries
overcoming initial difficulties and anxieties. Now after 424 cases we have evolved fairly safe methods to perform these surgeries. |
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