TCD, Minimally Invasive Cardiac Surgery, ECMO, Trans-Cranial Doppler. Mitral Valve Repair. Mark Mettauer, MD Zsolt Garami, MD Joseph Basha, CCP Stephanie Ibus, CCP

Mar 21, 2019Heart 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

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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 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 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, 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