Any help with these two reports is greatly appreciated. Doctor states that he did use bypass on either.
Placement of an RVAD (centrimag)
Pt was brought to the cath lab in an intubated condition and the area was prepped and draped in the usual sterile fashion. Under fluoroscopy and TEE the placement of the tip of the cannula was achieved in the main PA past the Pulmonic valve. We had used multiple dilators to dilate the tract and then the 26 F cannula was placed over the wire and positioned in the correct position. In the mean time a centrimag pump was primed and then wet to wet connections between the cannula and the pump was carried out. The pump was started and then under TEE guidance we gradually increased the speed and finally settled at 4000 rpm. At this speed the LV was filling well and the septum was midline. Excellent hemodynamics were noted. Once satisfied with the positioning the cannula was secured at multiple sites and sterile dressing placed.
Placement of a right ventricular assist device (tandem cannula through the
right IJ connected to a CentriMag RVAD pump).
The patient was brought to the Operating Room and
placed in a supine position. After induction of anesthesia, area was prepped
and draped in the usual sterile fashion. The previously closed temporary
dressing was taken down. A chest retractor was placed and the strut was
removed. Thorough investigation of all the cannulation sites were carried out. No bleeding was noted. Copious amount of saline was used with antibiotic solutions to irrigate the chest cavity. RV still appeared to be moderate to severely depressed. At that time, decision was made to put an RVAD through the right IJ. Previously placed one had already been repositioned through the left IJ with the Anesthesia Services. The Cordis was used to float a Swan. Once the Swan was then placed into the VA from the right IJ, the Cordis was removed and using that we were able to float in a 0.035 wire. Once the wire was in, the Swan was removed and the Cordis was removed and over this wire with gradual dilation, we were able to pass a malleable tandem cannula, 28-French in size.This was positioned under fluoroscopy as well as TEE. The tip of the cannula was passed the pulmonic valve. For this portion, Dr. X from Cardiology was available for help and helped in providing and maneuvering the cannula into the right position. Once that was done, the cannula was then de-aired and wet-to-wet connections with the RVAD were carried out. Once that was done, significant hemodynamic improvement was noted. Nitric oxide was weaned to lower levels as well as the milrinone and epinephrine.Once we were satisfied, the
patient was taken back to the Intensive Care Unit in a stable condition.
Terminal count of needles, sponges, and instrument was found to be correct
Placement of an RVAD (centrimag)
Pt was brought to the cath lab in an intubated condition and the area was prepped and draped in the usual sterile fashion. Under fluoroscopy and TEE the placement of the tip of the cannula was achieved in the main PA past the Pulmonic valve. We had used multiple dilators to dilate the tract and then the 26 F cannula was placed over the wire and positioned in the correct position. In the mean time a centrimag pump was primed and then wet to wet connections between the cannula and the pump was carried out. The pump was started and then under TEE guidance we gradually increased the speed and finally settled at 4000 rpm. At this speed the LV was filling well and the septum was midline. Excellent hemodynamics were noted. Once satisfied with the positioning the cannula was secured at multiple sites and sterile dressing placed.
Placement of a right ventricular assist device (tandem cannula through the
right IJ connected to a CentriMag RVAD pump).
The patient was brought to the Operating Room and
placed in a supine position. After induction of anesthesia, area was prepped
and draped in the usual sterile fashion. The previously closed temporary
dressing was taken down. A chest retractor was placed and the strut was
removed. Thorough investigation of all the cannulation sites were carried out. No bleeding was noted. Copious amount of saline was used with antibiotic solutions to irrigate the chest cavity. RV still appeared to be moderate to severely depressed. At that time, decision was made to put an RVAD through the right IJ. Previously placed one had already been repositioned through the left IJ with the Anesthesia Services. The Cordis was used to float a Swan. Once the Swan was then placed into the VA from the right IJ, the Cordis was removed and using that we were able to float in a 0.035 wire. Once the wire was in, the Swan was removed and the Cordis was removed and over this wire with gradual dilation, we were able to pass a malleable tandem cannula, 28-French in size.This was positioned under fluoroscopy as well as TEE. The tip of the cannula was passed the pulmonic valve. For this portion, Dr. X from Cardiology was available for help and helped in providing and maneuvering the cannula into the right position. Once that was done, the cannula was then de-aired and wet-to-wet connections with the RVAD were carried out. Once that was done, significant hemodynamic improvement was noted. Nitric oxide was weaned to lower levels as well as the milrinone and epinephrine.Once we were satisfied, the
patient was taken back to the Intensive Care Unit in a stable condition.
Terminal count of needles, sponges, and instrument was found to be correct