TCD, Minimally Invasive Cardiac Surgery, ECMO, Trans-Cranial Doppler. Mitral Valve Repair

TCD, Minimally Invasive Cardiac Surgery, ECMO, Trans-Cranial Doppler. Mitral Valve RepairMar 21, 2019Heart SurgeryLectures and panel discussion on Trans-Cranial Doppler, Novel approach for Minimally Invasive Mitral Valve Repair with Hyperkalemia, and management of the ECMO patient.Faculty: Mark Mettauer, MD Zsolt Garami, MD Joseph Basha, CCP Stephanie Ibus, CCPFaculty: Zsolt Garami, MDRegister to our next webinars @http://perfusioneducation.comPerfusion Education courses, CEUs and more:https://library.perfusioneducation.com0:00 Open9:16 TCD Basics For Perfusionist10:33 History of TCD (Trans-Cranial Doppler)11:29 power M mode TCD16:03 How signal from Trans-Cranial Doppler looks a like (flow changes, EGR, systolic upstroke)16:52 Normal flow pattern inside a middle cerebral artery and ACA (two carotid, occlusive disease)18:05 Transcranial Dopler – Adantages (non invasive evaluation of intracranial arteries establish utility in acute stroke), Vasomotor reactivity (breath holding index, hyperventilation), collateral circulation19:07 Collateral circulation in CAS20:26 Intracranial disease in ICA stenosis23:31 Breath holding index24:29 Trans Cranial Doppler represents ultimate method of cerebrovascular monitoring during carotid, aortic and valve interventions; stethoscope to the brain26:33 Microembolic signal MES27:52 Embolus track on power M mode Doppler Faculty Joseph Basha, CCP33:23 What do we perfuse? (body, limbs, heart, kidneys, liver, gut)Faculty Joseph Basha, CCP34:46 How we measure adequacy of perfusion (SVO2, DO2, cerebral oximetry)37:45 Stroke – periooperative stroke rates in cardiac surgery range 1.7% to 2.9%; Encephalopathy rates 7.7% to 13.8%41:55 Off pump or on pump coronary artery bypass grafting at 30 days43:40 Primary outcome between off pump CABG and on pump CABG44:42 TAVR and stroke an awaking49:32 A catheter is guided through the femoral artery49:57 New valve is deployed via catheter54:53 The pump is not free of the stroke risk (Hypoperfusion, embolic gas or particulate Hypocarbia, Cannula position, drainage, failure1:02:34 Detection and elimination if microemboli related to cardiopulmonary bypass Faculty: Zsolt Garami, MD1:09:37 Intraoperative Trans-Cranial Doppler monitoring1:11:15 Practice standards for Trans-Cranial Doppler (TCD) ultrasound1:14:35 Trans-Cranial Doppler in Carotid Stenosis1:15:40 TCD screen: bilateral MCA monitoring, contrast injection vs MES vs macro embolus1:16:56 TCD MCA occlusion; macroembolus MCA clot1:20:00 CEA – bilateral carotid stenosis1:21:39 CEA monitoring clamp on1:23:25 CAS monitoring1:27:18 Bypass initiation1:35:35 Cerebral Ischemia after TAVI1:36:12 Results Trans-Cranial Doppler findings1:36:53 BAV – TAVI1:40:42 TAVR monitoringFaculty: Mark Mettauer, MD2:18:30 Simplifying minimally invasive MVR2:21:05 Reason to try minimally invasive MVR (simplification)2:22:26 Surgeon standpoint is the technology for access (minimally invasive type of retractor, atrial lift)2:24:23 Mitral valve surgery generally is hardest most difficult to do in the chest2:24:38 Images of severe regurgitation (previous mitral endocarditis, perforated valves, core matrix)2:26:32 Continuously perfusing the coronaries with oxygenated blood2:29:12 Aspect of atrium2:29:45 Direct view in the hearts, irreparable valve (diseased) annulus is calcified2:30:44 Removing the valve2:31:05 Time constraint of cardioplegia (retrograde perfusion)2:32:10 Potasium – intravenous dose of high dose potassium with the aid of the heart lung machine and a competent or moderately competently ordered valve2:33:12 Cross clamp using endo balloon2:34:28 Overrated suture – David op method (12 sutures for replacement valve, shaves off 30 min)2:36:06 Checking the valve, CO22:36:25 Testing the mechanical valve2:36:45 View of anterior portion of annulus (atrial lifter out)2:37:05 Using of ventricular wires2:38:10 Superior pulmonary veins2:39:10 Filling the heart, rewarming patient, stop the potassium, hearts the LV decompressed although the right heart2:39:42 Dual lumen tube – contraindication, adhesions2:41:36 JP drains in the pericardial space, posterior lee in the pleural space2:41:48 decannulated repaired arteriesFaculty: Stephanie Ibus, CCP2:53:56 CVVH plasma water replacement fluid for potassium K removal2:55:40 HyperkalemiaFaculty: Mark Mettauer, MD Zsolt Garami, MD Joseph Basha, CCP Stephanie Ibus, CCP

TCD, Minimally Invasive Cardiac Surgery, ECMO, Trans-Cranial Doppler. Mitral Valve Repair

Mar 21, 2019Heart Surgery

Mar 21, 2019 Heart Surgery

Lectures and panel discussion on Trans-Cranial Doppler, Novel approach for Minimally Invasive Mitral Valve Repair with Hyperkalemia, and management of the ECMO patient.

Faculty: Mark Mettauer, MD Zsolt Garami, MD Joseph Basha, CCP Stephanie Ibus, CCP

Faculty: Zsolt Garami, MD

Register to our next webinars @http://perfusioneducation.com

Perfusion Education courses, CEUs and more:https://library.perfusioneducation.com

Perfusion Education courses, CEUs and more: https://library.perfusioneducation.com

0:00 Open9:16 TCD Basics For Perfusionist10:33 History of TCD (Trans-Cranial Doppler)11:29 power M mode TCD16:03 How signal from Trans-Cranial Doppler looks a like (flow changes, EGR, systolic upstroke)16:52 Normal flow pattern inside a middle cerebral artery and ACA (two carotid, occlusive disease)18:05 Transcranial Dopler – Adantages (non invasive evaluation of intracranial arteries establish utility in acute stroke), Vasomotor reactivity (breath holding index, hyperventilation), collateral circulation19:07 Collateral circulation in CAS20:26 Intracranial disease in ICA stenosis23:31 Breath holding index24:29 Trans Cranial Doppler represents ultimate method of cerebrovascular monitoring during carotid, aortic and valve interventions; stethoscope to the brain26:33 Microembolic signal MES27:52 Embolus track on power M mode Doppler Faculty Joseph Basha, CCP33:23 What do we perfuse? (body, limbs, heart, kidneys, liver, gut)

0:00 Open

9:16 TCD Basics For Perfusionist

10:33 History of TCD (Trans-Cranial Doppler)

11:29 power M mode TCD

16:03 How signal from Trans-Cranial Doppler looks a like (flow changes, EGR, systolic upstroke)

16:52 Normal flow pattern inside a middle cerebral artery and ACA (two carotid, occlusive disease)

18:05 Transcranial Dopler – Adantages (non invasive evaluation of intracranial arteries establish utility in acute stroke), Vasomotor reactivity (breath holding index, hyperventilation), collateral circulation

19:07 Collateral circulation in CAS

20:26 Intracranial disease in ICA stenosis

23:31 Breath holding index

24:29 Trans Cranial Doppler represents ultimate method of cerebrovascular monitoring during carotid, aortic and valve interventions; stethoscope to the brain

26:33 Microembolic signal MES

27:52 Embolus track on power M mode Doppler Faculty Joseph Basha, CCP

33:23 What do we perfuse? (body, limbs, heart, kidneys, liver, gut)

Faculty Joseph Basha, CCP

34:46 How we measure adequacy of perfusion (SVO2, DO2, cerebral oximetry)37:45 Stroke – periooperative stroke rates in cardiac surgery range 1.7% to 2.9%; Encephalopathy rates 7.7% to 13.8%41:55 Off pump or on pump coronary artery bypass grafting at 30 days43:40 Primary outcome between off pump CABG and on pump CABG44:42 TAVR and stroke an awaking49:32 A catheter is guided through the femoral artery49:57 New valve is deployed via catheter54:53 The pump is not free of the stroke risk (Hypoperfusion, embolic gas or particulate Hypocarbia, Cannula position, drainage, failure1:02:34 Detection and elimination if microemboli related to cardiopulmonary bypass Faculty: Zsolt Garami, MD1:09:37 Intraoperative Trans-Cranial Doppler monitoring1:11:15 Practice standards for Trans-Cranial Doppler (TCD) ultrasound1:14:35 Trans-Cranial Doppler in Carotid Stenosis1:15:40 TCD screen: bilateral MCA monitoring, contrast injection vs MES vs macro embolus1:16:56 TCD MCA occlusion; macroembolus MCA clot1:20:00 CEA – bilateral carotid stenosis1:21:39 CEA monitoring clamp on1:23:25 CAS monitoring1:27:18 Bypass initiation1:35:35 Cerebral Ischemia after TAVI1:36:12 Results Trans-Cranial Doppler findings1:36:53 BAV – TAVI1:40:42 TAVR monitoring

34:46 How we measure adequacy of perfusion (SVO2, DO2, cerebral oximetry)

37:45 Stroke – periooperative stroke rates in cardiac surgery range 1.7% to 2.9%; Encephalopathy rates 7.7% to 13.8%

41:55 Off pump or on pump coronary artery bypass grafting at 30 days

43:40 Primary outcome between off pump CABG and on pump CABG

44:42 TAVR and stroke an awaking

49:32 A catheter is guided through the femoral artery

49:57 New valve is deployed via catheter

54:53 The pump is not free of the stroke risk (Hypoperfusion, embolic gas or particulate Hypocarbia, Cannula position, drainage, failure

1:02:34 Detection and elimination if microemboli related to cardiopulmonary bypass Faculty: Zsolt Garami, MD

1:09:37 Intraoperative Trans-Cranial Doppler monitoring

1:11:15 Practice standards for Trans-Cranial Doppler (TCD) ultrasound

1:14:35 Trans-Cranial Doppler in Carotid Stenosis

1:15:40 TCD screen: bilateral MCA monitoring, contrast injection vs MES vs macro embolus

1:16:56 TCD MCA occlusion; macroembolus MCA clot

1:20:00 CEA – bilateral carotid stenosis

1:21:39 CEA monitoring clamp on

1:23:25 CAS monitoring

1:27:18 Bypass initiation

1:35:35 Cerebral Ischemia after TAVI

1:36:12 Results Trans-Cranial Doppler findings

1:36:53 BAV – TAVI

1:40:42 TAVR monitoring

Faculty: Mark Mettauer, MD

2:18:30 Simplifying minimally invasive MVR2:21:05 Reason to try minimally invasive MVR (simplification)2:22:26 Surgeon standpoint is the technology for access (minimally invasive type of retractor, atrial lift)2:24:23 Mitral valve surgery generally is hardest most difficult to do in the chest2:24:38 Images of severe regurgitation (previous mitral endocarditis, perforated valves, core matrix)2:26:32 Continuously perfusing the coronaries with oxygenated blood2:29:12 Aspect of atrium2:29:45 Direct view in the hearts, irreparable valve (diseased) annulus is calcified2:30:44 Removing the valve2:31:05 Time constraint of cardioplegia (retrograde perfusion)2:32:10 Potasium – intravenous dose of high dose potassium with the aid of the heart lung machine and a competent or moderately competently ordered valve2:33:12 Cross clamp using endo balloon2:34:28 Overrated suture – David op method (12 sutures for replacement valve, shaves off 30 min)2:36:06 Checking the valve, CO22:36:25 Testing the mechanical valve2:36:45 View of anterior portion of annulus (atrial lifter out)2:37:05 Using of ventricular wires2:38:10 Superior pulmonary veins2:39:10 Filling the heart, rewarming patient, stop the potassium, hearts the LV decompressed although the right heart2:39:42 Dual lumen tube – contraindication, adhesions2:41:36 JP drains in the pericardial space, posterior lee in the pleural space2:41:48 decannulated repaired arteries

2:18:30 Simplifying minimally invasive MVR

2:21:05 Reason to try minimally invasive MVR (simplification)

2:22:26 Surgeon standpoint is the technology for access (minimally invasive type of retractor, atrial lift)

2:24:23 Mitral valve surgery generally is hardest most difficult to do in the chest

2:24:38 Images of severe regurgitation (previous mitral endocarditis, perforated valves, core matrix)

2:26:32 Continuously perfusing the coronaries with oxygenated blood

2:29:12 Aspect of atrium

2:29:45 Direct view in the hearts, irreparable valve (diseased) annulus is calcified

2:30:44 Removing the valve

2:31:05 Time constraint of cardioplegia (retrograde perfusion)

2:32:10 Potasium – intravenous dose of high dose potassium with the aid of the heart lung machine and a competent or moderately competently ordered valve

2:33:12 Cross clamp using endo balloon

2:34:28 Overrated suture – David op method (12 sutures for replacement valve, shaves off 30 min)

2:36:06 Checking the valve, CO2

2:36:25 Testing the mechanical valve

2:36:45 View of anterior portion of annulus (atrial lifter out)

2:37:05 Using of ventricular wires

2:38:10 Superior pulmonary veins

2:39:10 Filling the heart, rewarming patient, stop the potassium, hearts the LV decompressed although the right heart

2:39:42 Dual lumen tube – contraindication, adhesions

2:41:36 JP drains in the pericardial space, posterior lee in the pleural space

2:41:48 decannulated repaired arteries

Faculty: Stephanie Ibus, CCP2:53:56 CVVH plasma water replacement fluid for potassium K removal2:55:40 Hyperkalemia

Faculty: Stephanie Ibus, CCP

2:53:56 CVVH plasma water replacement fluid for potassium K removal

2:55:40 Hyperkalemia

Faculty: Mark Mettauer, MD Zsolt Garami, MD Joseph Basha, CCP Stephanie Ibus, CCP