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207 results on '"Cobey, Frederick C."'

42. Paravertebral analgesia in transapical transcatheter aortic valve replacement

Author

Poltak, Justin M, Cobey, *Frederick C, Augoustides, John G, and Connors, Christopher W

Subjects
Letter, paravertebral, transcatheter, Research-Article, analgesia, atrial fibrillation, aortic valve replacement, transapical
Abstract

Introduction Transapical transcatheter aortic valve replacement is an option for patients who are not candidates for traditional aortic valve surgery but have severe aortic stenosis and unfavorable ileo-femoral anatomy. Epidural analgesia in these cases has been associated with improved morbidity and mortality. The following manuscript presents the findings of an initial clinical experience employing paravertebral analgesia for patients undergoing transapical transcatheter aortic valve replacement. Methods A retrospective review was performed of 61 transapical transcatheter aortic valve replacement cases over a two-year period from November 2012 through July 2014. Paravertebral analgesia was provided as left sided single injections covering 1-3 dermatome levels using 0.2% ropivicaine with supplemental clonidine to 48 patients. The following outcome metrics were collected: 1) peri-operative opiate administration, 2) rate of extubation in the operating room, 3) new atrial fibrillation, 4) duration of intensive care stay, 5) 30-day mortality. Results The mean opiate administration was less in patients with paravertebral analgesia (128.65mcg vs. 163.46mcg fentanyl, p value 0.05) and these patients were more frequently extubated in the operating room (83.3% vs. 46.2%, p-value 0.0107). Incidence of atrial fibrillation was less in patients who received paravertebral analgesia (18.8% vs. 75.0%, p-value 0.0048). There was a non-significant trend towards decreased intensive care stay in patients who received paravertebral analgesia (58.3 hrs vs 75.8 hrs, p value 0.35). There was no difference in 30-day mortality. No complications resulted from paravertebral analgesia. Conclusions This is the first reported case series of paravertebral blockade in transapical transcatheter aortic valve replacement patients. The findings suggest that paravertebral single shot blocks are both safe and practical for use in this patient population. A formal prospective investigation of paravertebral analgesia in these patients is warranted.

Published
2015

48. Chronic postthoracotomy pain in transapical transcatheter aortic valve replacement.

Author

Gebhardt, Brian, Jain, Ankit, Basaham, Sarah, Zahedi, Farhad, Ianchulev, Stefan, Brinckerhoff, Larry, Augoustides, John, Patel, Prakash, Tsai, Andrea, Cobey, Frederick, Gebhardt, Brian R, Basaham, Sarah A, Brinckerhoff, Larry H, Augoustides, John G, Patel, Prakash A, and Cobey, Frederick C

Subjects
AORTIC valve, CHRONIC pain, CARDIOMYOPATHIES, MCGILL Pain Questionnaire, TELEPHONE interviewing, THORACIC surgery
Abstract

Objective: Chronic postthoracotomy pain (CPTP) is a persistent, occasionally debilitating pain lasting >2 months following thoracic surgery. This study investigates for the first time the prevalence and clinical impact of CPTP in patients who have undergone a transapical transcatheter aortic valve replacement (TA-TAVR).Design: This was a single-institution, prospective observational survey and a retrospective chart review.Setting: The study was conducted in the University Hospital.Participants: Patients.Materials and Methods: A survey of 131 participants with either a previous TA TAVR or transfemoral (TF) TAVR procedure was completed. A telephone interview was conducted at least 2 months following TAVR; participants were asked to describe their pain using the Short-Form McGill Pain Questionnaire.Measurements and Main Results: Odds ratio (OR) was calculated using the proportions of questionnaire responders reporting "sensory" descriptors in the TA-TAVR versus the TF-TAVR groups. Results were then compared to individual Kansas City Cardiomyopathy Questionnaire (KCCQ12) scores and 5-min walk test (5MWT) distances. A total of 119 participants were reviewed (63 TF, 56 TA). Among TA-TAVR questionnaire responders (n = 16), CPTP was found in 64.3% of participants for an average duration of 20.5-month postprocedure (OR = 10, [confidence interval (CI) 95% 1.91-52.5];P = 0.003). TA-TAVR patients identified with CPTP had significant reductions in 5MWT distances (-2.22 m vs. 0.92 m [P = 0.04]) as well as trend toward significance in negative change of KCCQ12 scores OR = 18.82 (CI 95% 0.85-414.99;P = 0.06) compared to those without CPTP.Conclusions: CPTP occurs in patients undergoing TA-TAVR and is possibly associated with a decline quality of life and overall function. [ABSTRACT FROM AUTHOR]

Published
2019
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