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Joshi P, Borde D, Apsingekar P, Pande S, Tandale M, Deodhar A, Jangle S. Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence. Ann Card Anaesth 2024; 27:169-174. [PMID: 38607883 DOI: 10.4103/aca.aca_107_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/23/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.
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Affiliation(s)
- Pooja Joshi
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Deepak Borde
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingekar
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Swati Pande
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Mangesh Tandale
- Department of Plastic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
| | - Anand Deodhar
- Department of Cardiovascular and Thoracic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
| | - Sachin Jangle
- Department of Plastic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
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Borde D, C K, Jasapara A, Shetty V, Juvekar N, Desurkar V, Gaidu J, Joshi P, Asegaonkar B, Kp U, V V, Joshi S, Koshy T. Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study. J Cardiothorac Vasc Anesth 2022; 36:4289-4295. [PMID: 36038439 DOI: 10.1053/j.jvca.2022.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. DESIGN A multicenter randomized control study. SETTING At 5 tertiary care level hospitals. PARTICIPANTS Three hundred sixty-three adult patients undergoing elective cardiac surgery. INTERVENTIONS The patients were randomized into 2 groups-the conventional group (C group; n = 177) and the VL group (n = 186) for TEE probe insertion. MEASUREMENTS AND MAIN RESULTS The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n = 26; 14.7%) compared to the VL group (n = 14; 7.5%; p = 0.029). The number of attempts for probe insertion was significantly lower in the VL group (p = 0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n = 88; 47%), followed by posterior (n = 77; 41%) and lateral (n = 21;12%). CONCLUSION The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar C
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
| | - Nilesh Juvekar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Vinayak Desurkar
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Jyoti Gaidu
- Department of Cardiac Anesthesia, Deenanath Maneshkar Hospital, Pune, Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unnikrihnan Kp
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vipinraj V
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Thomas Koshy
- Department of Cardiac Anesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Joshi P, Borde D, Asegaonkar B, Daunde V, Joshi S, Jaspara A. Utility of E point septal separation as screening tool for left ventricular ejection fraction in perioperative settings by anesthetists. Ann Card Anaesth 2022; 25:304-310. [PMID: 35799558 PMCID: PMC9387623 DOI: 10.4103/aca.aca_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Left ventricular (LV) systolic dysfunction is a common cause of hemodynamic disturbance perioperatively and is associated with increased morbidity and mortality. Echocardiographic evaluation of left ventricular systolic function (LVSF) has great clinical utility. This study was aimed to test the hypothesis that LVSF assessed by an anesthetist using mitral valve E Point Septal Separation (EPSS) has a significant correlation with that assessed using modified Simpson's method perioperatively. Methods This prospective observational study included 100 patients scheduled for elective surgeries. Transthoracic echocardiography (TTE) was performed preoperatively within 24 hours of surgery by an anesthetist as per American Society of Echocardiography (ASE) guidelines. EPSS measurements were obtained in parasternal long-axis view while volumetric assessment of LV ejection fraction (EF) used apical four-chamber view. Bivariate analysis of EPSS and LV EF was done by testing Pearson correlation coefficient. Receiver Operating Characteristic (ROC) curve constructed to obtain area under curve (AUC) and Youden's Index. Results The mean value of mitral valve EPSS was 7.18 ± 3.95 mm. The calculated mean LV EF value using volumetric analysis was 56.31 ± 11.92%. LV dysfunction as per ASE guidelines is present in 28% of patients. EPSS was statistically significantly related to LV EF negatively with a Pearson coefficient of -0.74 (P < 0.0001). AUC of ROC curve 0.950 (P < 0.0001) suggesting a statistically significant correlation between EPSS and LV EF. Youden's index of EPSS value 7 mm was obtained to predict LV systolic dysfunction. Conclusion Mitral valve EPSS shows a significant negative correlation with gold standard LVEF measurement for LVSF estimation. It can very well be used to assess LVSF perioperatively by anesthetists with brief training.
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Affiliation(s)
- Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Vijay Daunde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
| | - Amish Jaspara
- Department of Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtra, India
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Borde D, Asegaonkar B, Shreedhar J. CORRELATION OF MITRAL ANNULAR PLANE SYSTOLIC EXCURSION (MAPSE) WITH LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN (GLS) IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY. J Cardiothorac Vasc Anesth 2021. [DOI: 10.1053/j.jvca.2021.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Borde D, Joshi P, Asegaonkar B, Agrawal A. Perioperative Changes in Global Myocardial Work Indices in a Patient With Severe Aortic Stenosis With Severe Left Ventricular Dysfunction Undergoing Surgical Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2021; 36:2060-2065. [PMID: 34389212 DOI: 10.1053/j.jvca.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Ashish Agrawal
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
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Borde D, Chidambaram K, Sundar AS, Kulkarni V, Jasapara A, Shetty V, Gopinath R, Pathy A, Viswanath VVR, Asegaonkar B, Apsingkar P, Takalkar U, Joshi S, Chakravarthy M. Normative Transesophageal Echocardiographic Values of Cardiac Structures in the Indian Population-Indian Normative TEE Measurements (INTEEM) Study. J Cardiothorac Vasc Anesth 2021; 36:184-194. [PMID: 34344599 DOI: 10.1053/j.jvca.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data. DESIGN The Indian Normative TEE Measurements study was a multicenter, prospective observational study conducted in India. SETTING Operating rooms for noncardiac surgeries in tertiary care-level hospitals. PARTICIPANTS Adult patients undergoing noncardiac surgery who were free from any cardiac, respiratory, and renal diseases and had no contraindications for TEE. INTERVENTIONS After inducing general anesthesia and achieving stable hemodynamic conditions, a comprehensive TEE examination was performed and various measurements were made. MEASUREMENTS AND MAIN RESULTS For each of the 83 patients undergoing noncardiac surgery, 39 various measurements for left ventricle, right ventricle, both atria, and all valves were made. This included diameters and functional parameters. They were analyzed in a vendor-neutral software off-line. The absolute values of many of the measurements were higher in men, but when indexed to body surface area (BSA) they were similar in both sexes. The values were lower than most of the Western data but matched previous Indian studies using TTE. CONCLUSIONS The authors present normative values of various echocardiographic parameters using TEE. Because of its variations, it is recommended to use India-specific data to make decisions in Indian patients. It may be prudent to use BSA-indexed values during decision-making.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Kumar Chidambaram
- Department of Cardiac Anesthesia, Madras Medical Mission, Chennai, Tamilnadu, India
| | - Ayya Syama Sundar
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India; Department of Anesthesiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Venugopal Kulkarni
- Department of Cardiac Anesthesia, Citizen's Hospital, Hyderabad, Telangana, India
| | - Amish Jasapara
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtera, India
| | - Vijay Shetty
- Department of Cardiac Anesthesia, Fortis Hospitals, Mulund, Mumbai, Maharashtera, India
| | - Ramachandra Gopinath
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India; Department of Anesthesiology, ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India
| | - Archana Pathy
- Department of Cardiac Anesthesia, Nizam's Institute of Medical Sciences, Hyderabad, Telanagana, India
| | - V V Raja Viswanath
- Department of Cardiac Anesthesia, Citizen's Hospital, Hyderabad, Telangana, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Unmesh Takalkar
- Department of Surgery, United CIIGMA Hospital, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Murali Chakravarthy
- Department of Cardiac Anesthesia, Fortis Hospitals, Bengaluru, Karnataka, India
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Borde D, Joshi S, Jasapara A, Joshi P, Asegaonkar B, Apsingekar P. Left Atrial Strain as a Single Parameter to Predict Left Ventricular Diastolic Dysfunction and Elevated Left Ventricular Filling Pressure in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:1618-1625. [PMID: 33384229 DOI: 10.1053/j.jvca.2020.11.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Left ventricular diastolic dysfunction (LVDD) is very common among patients undergoing cardiac surgery and is associated with increased mortality and morbidity. The present study tested the hypothesis of whether left atrial strain (LAS) can be used as a single parameter to predict LVDD (per 2016 LVDD evaluation guidelines) and elevated left ventricular filling pressure (LVFP) (ie, LVDD grades II and III) in patients scheduled for off-pump coronary artery bypass grafting (OPCABG) surgery. DESIGN A prospective observational study. SETTINGS Tertiary-care level hospital. PARTICIPANTS The study comprised 60 patients undergoing elective OPCABG. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Transthoracic echocardiography was performed within 24 hours of surgery by an anesthesiologist. LVDD was graded per American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations for 2016 LVDD guidelines. Left atrial (LA) function was evaluated using two-dimensional strain measurements obtained with the speckle-tracking echocardiography technique. Receiver operating characteristic curves were constructed, and the area under the curve was derived for the prediction of elevated LVFP by LAS. Fourteen (23.3%) patients had elevated LVFP. Global LA reservoir strain (LASr) reduced significantly as the LVDD grade worsened (28.9% ± 8.3%, 21.8% ± 7.2%, 15.6% ± 4.5% and 11.9% ± 1.3%, respectively, for normal LV diastolic function and grades I, II, and III LVDD; p < 0.0001). Similar trends were noted for other components of LAS; namely, global LA conduction, global LA contraction strain, and LAS rate. The ability to predict high LVFP with LASr was statistically significant, with an area under the receiver operating characteristic curve of 0.92 (confidence interval 0.82-0.97; p < 0.001), and a Youden's index for LASr of 19% was obtained with 85.71% sensitivity and 84.78% specificity. The ability of LAS and its components to predict increased LVFP in various subpopulations (normal v reduced ejection fraction) yielded statistically significant results. CONCLUSIONS In patients scheduled for OPCABG, cardiac anesthesiologists successfully could measure LAS with speckle-tracking echocardiography in the preoperative period. LAS as a single parameter was significantly associated with the grade of LVDD. LASr decreased significantly with worsening grade of LVDD. Furthermore, an LASr value <19% significantly predicted a high LVFP, and LASr predicted high LVFP in both preserved and reduced ejection fraction equally well.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
| | - Amish Jasapara
- Department of Anesthesia, Fortis Hospitals, Mulund, Mumbai Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingekar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
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Borde D, Joshi P, Joshi S, Asegaonkar B, Apsingekar P, Khade S, Pande S, Agrawal A, Puranik M. Changes in Right Ventricular Function After Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:811-819. [PMID: 32739088 DOI: 10.1053/j.jvca.2020.06.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Right ventricular (RV) dysfunction is associated with poor outcomes after cardiac surgery. The aim of this study was to assess RV systolic and diastolic function in the perioperative period after off-pump coronary artery bypass grafting (OPCAB). DESIGN Prospective observational study. SETTINGS Tertiary care hospital. PARTICIPANTS Thirty adult patients undergoing OPCAB. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Transthoracic echocardiography was performed twice: first preoperatively and second postoperatively, when patients were moved to wards. The following five parameters of RV systolic function were used: tricuspid annular plane systolic excursion (TAPSE), systolic tissue Doppler imaging of lateral tricuspid annulus (S'), fractional area change (FAC), RV myocardial performance index (RIMP), and isovolumic acceleration (IVA). Grading of RV diastolic function (RVDD) was done as per guidelines. Paired t test was used for comparing means and χ2 test was used for categorical and ordinal data. The parameters of RV longitudinal function (TAPSE and S') reduced significantly (preoperative 21.93 ± 2.80 mm and 13.24 ± 2.24 cm/s to postoperative 11.67 ± 1.91 mm and 10.31 ± 1.56 cm/s, respectively, p < 0.001), whereas parameters of RV global function (FAC, RIMP, and IVA) remained preserved (preoperative 46.75 ± 6.80%, 0.34 ± 0.06, and 4.66 ± 0.87 m/s2 to postoperative 46.21 ± 6.44%, 0.36 ± 0.06, and 4.37 ± 0.83 m/s2; p values of 0.76, 0.13, and 0.11, respectively). The median grade of RVDD worsened from normal in the preoperative period to pseudo-normal in the postoperative period (p < 0.001). The changes in both RV systolic and diastolic function were similar in patients with normal and reduced left ventricular systolic function. CONCLUSIONS RV function can be assessed in perioperative settings with two-dimensional and tissue Doppler imaging. For systolic function assessment, exclusive measurement of longitudinal parameters might be inadequate; use of complementary global parameters like FAC, RIMP, and IVA is essential to complete the RV assessment after OPCAB. RVDD worsened significantly after OPCABG.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingekar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Sujeet Khade
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Swati Pande
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Ashish Agrawal
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
| | - Manish Puranik
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
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Borde D, Joshi S, Asegaonkar B, Apsingekar P, More S, Deodhar A. MAPSE – a simple, reliable parameter of LV systolic function in patients undergoing OPCABG. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Borde D, Futane S, Asegaonkar B, Puranik M, Sargar S. Effect of perioperative pregabalin on post- operative quality of recovery in patients undergoing off pump coronary artery bypass grafting (OPCABG - prospective, randomized, double blind study. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Borde D, Asegaonkar B, Apsingekar P, Khade S, Futane S, Annachhatre A, Puranik M, Belapurkar Y, Deodhar A, George A, Joshi S. Intraoperative conversion to on pump CABG is independently associated with higher mortality in patients undergoing off pump CABG - a propensity matched analysis. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Borde D, Joshi S, George A. Reply. J Cardiothorac Vasc Anesth 2016; 30:e31-2. [PMID: 26947711 DOI: 10.1053/j.jvca.2015.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak Borde
- Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Antony George
- Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Borde D, Asegaonkar B, Apsingekar P, Khade S, Futane S, Khodve B, Annachatre A, Puranik M, Borgaonkar V, Belapurkar Y, Joshi S. Risk Stratification in Off-Pump Coronary Artery Bypass (OPCAB) Surgery—Role of EuroSCORE II. J Cardiothorac Vasc Anesth 2015; 29:1167-71. [PMID: 26275518 DOI: 10.1053/j.jvca.2015.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the EuroSCORE II for risk stratification in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN A retrospective observational study. SETTING Two tertiary care hospitals. PARTICIPANTS Participants were 1,211 patients undergoing OPCAB surgery. INTERVENTIONS No interventions were implemented. MEASUREMENTS AND MAIN RESULTS The EuroSCORE II estimated the operative risk for each patient. The calibration of the scoring system was assessed using the Hosmer Lemeshow test, and the discriminative capacity was estimated with area under receiver operating characteristic curves. The incidence, patient characteristics, causes of intraoperative conversion to on-pump coronary artery bypass (ONCAB), and outcome were studied. The all-cause in-hospital mortality was 2.39%. Predicted mortality with the EuroSCORE II was 2.03±1.63. Using the Hosmer Lemeshow test, a C statistic of 8.066 (p = 0.472) was obtained, indicating satisfactory model fit. The calculated area under the receiver operating characteristic curve was 0.706 (p = 0.0002), indicating good discriminatory power. Emergency intraoperative conversion to ONCAB occurred in 6.53% of patients. The mortality in the ONCAB group was significantly higher compared with patients who underwent successful OPCAB surgery (15.18% v 1.5%, p<0.0001). On multiple regression analysis with conversion to ONCAB as the endpoint, associated factors were patients with a higher EuroSCORE II (odds ratio = 1.13, confidence interval = 1.03-1.27) and more-than-trivial mitral regurgitation (odds ratio = 1.84, confidence interval = 1.07-3.06). Net reclassification improvement of 0.714 (p<0.0001) was obtained when on-pump conversion was added to the EuroSCORE II. CONCLUSIONS The EuroSCORE II has satisfactory calibration and discrimination power to predict mortality after OPCAB surgery. Intraoperative conversion to ONCAB is a major complication of OPCAB surgery. A higher EuroSCORE II also predicts higher probability of conversion to ONCAB.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Vijay Borgaonkar
- Department of Surgery, Seth Nandlad Dhoot Hospital, Aurangabad, M.S
| | - Yogesh Belapurkar
- Department of Cardiac Surgery, M.G.M. Medical College and Hospital, Aurangabad, M.S
| | - Shreedhar Joshi
- Department of Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
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Borde D, Gandhe U, Hargave N, Mathew M, Joshi S, Pandey K. Prediction of postoperative atrial fibrillation after coronary artery bypass grafting surgery: Is CHA2DS2-VASc score useful? Ann Card Anaesth 2014; 17:182-7. [DOI: 10.4103/0971-9784.135841] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. Authors' reply. Ann Card Anaesth 2013; 16:300-1. [PMID: 24288836 DOI: 10.4103/0971-9784.119187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Borde D, Gandhe U, Hargave N, Pandey K. Management of patients with hematological malignancies undergoing coronary artery bypass grafting. Ann Card Anaesth 2013; 16:47-50. [DOI: 10.4103/0971-9784.105370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anaesth 2013; 16:163-6. [DOI: 10.4103/0971-9784.114234] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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