Anesthetic Management of Transapical Off-Pump Mitral Valve Repair With NeoChord Implantation.
OBJECTIVE
Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure.


METHODS
An observational study.


METHODS
Training and research hospital.


METHODS
Adult patients who underwent MV repair with the NeoChord DS1000 system (NeoChord Inc, St Louis Park, MN).


METHODS
The study included 12 consecutive patients who underwent MV repair with the NeoChord DS1000 system at the Antalya Training and Research Hospital, Antalya, Turkey, between June 2014 and December 2015. A record was made of preoperative demographic details, comorbidities, preoperative and postoperative mitral regurgitation severity, preoperative and postoperative forced expiratory volume in 1 second values, use of blood products and vasoactive drugs, surgical times, mechanical ventilation times, intensive care unit (ICU) and hospital length of stay, visual analog scale scores, analgesic requirement in ICU and perioperative complications.


RESULTS
TOP-MINI was performed completely off-pump in 12 patients. Intraoperative salvaged blood via cell-saver was 660±196 mL. Patients required 0.8±0.7 U of red blood cells and 2.0±0.9 U of fresh frozen plasma in the ICU. Inotropic support was used in 5 patients. There was a significant decline in mean arterial pressure from before surgery to during implantation (70.9±4.5 mmHg v 51.7±5.8 mmHg, respectively). A statistically significant increase was demonstrated in mean arterial pressure from during implantation to postimplantation (51.7±5.8 mmHg v 67.0±6.8 mmHg, respectively). There were no significant differences in preoperative and postoperative forced expiratory volume in 1 second values. Defibrillation was required in 1 patient, and temporary atrial fibrillation was observed in 1 patient during the procedure. Atelectasis occurred in the postoperative period in 1 patient. The mean visual analog scale score was 3.6±1.4, and the mean tramadol consumption was 77±39 mg in the ICU. Extubation time and the mean length of stay in the ICU and hospital were 2.6±0.5 hours, 19.8±2.7 hours, 5±1 days, respectively.


CONCLUSIONS
The TOP-MINI procedure requires complex anesthetic management. Transesophageal echocardiographic guidance is essential for this procedure. One-lung ventilation, fluid administration, avoidance of hypothermia, and pain management are the bases for anesthetic management.
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey. Electronic address: alisaitkavakli@hotmail.com.
Ali Sait
AS
Kavakli
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey.
Nilgun Kavrut
NK
Ozturk
Department of Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey.
Raif Umut
RU
Ayoglu
Department of Cardiovascular Surgery, Antalya Education and Research Hospital, Antalya, Turkey.
Mustafa
M
Emmiler
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey.
Lutfi
L
Ozyurek
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey.
Kerem
K
Inanoglu
Department of Anaesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Turkey.
Sadik
S
Ozmen
D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous; D005260:Female; D005283:Fentanyl; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D003473:Neuromuscular Nondepolarizing Agents; D015742:Propofol; D000077123:Rocuronium; D016896:Treatment Outcome
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D008874:Midazolam; D005283:Fentanyl; D000077123:Rocuronium; D015742:Propofol
NeoChord procedure; anesthetic management; mitral valve repair; off-pump; transapical