New Approaches to the Surgical Treatment of End-Stage Heart Failure

Stone, Marc E.; Arica, Koray; Hayashi, Masao; Fischer, Gregory W.

doi:10.1016/b978-1-4377-1617-7.00025-x

Cited by 1 publication

(1 citation statement)

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“…Anesthetic goals include avoiding disturbances in preload, heart rate, afterload, and oxygenation. Inotropes and vasopressors were ready for use when needed, keeping in mind that elevation of SVR would worsen the AR [14]. We decided to proceed with a small dose of ketamine for its potent analgesic properties and its ability to maintain spontaneous respiration.…”

Section: Discussionmentioning

confidence: 98%

Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis

et al. 2011

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We report a case of an adult male who had received a gunshot to the abdomen 12 years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF). Following endovascular repair of the ACF, we observed an immediate rise in systemic vascular resistance (SVR), decrease in central venous pressure (CVP), increase in regurgitant flow across the aortic valve, and decrease in central mixed venous oxygenation. A combination of vasodilators and vasopressors was used to maintain hemodynamics. Milrinone infusion was necessary after cardiopulmonary bypass to maintain cardiac output. Even though local anesthesia and light sedation were used for ACF closure, the hemodynamics changed dramatically throughout the procedure. ACF closure under local anesthesia and sedation is preferred because the hemodynamics alterations under local anesthesia are less severe. The rise in SVR and regurgitant flow across aortic valve is less dramatic. As a result, hemodynamic management and separation from cardiopulmonary bypass are easier.

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Section: Discussionmentioning

confidence: 98%