Himani V. Bhatt, DO, Morgan L. Montgomery, MD, Alexander J.C. Mittnacht, MD, Ali Shariat, MD, Ahmed El-Eshmawi, MD, David H. Adams, MD, Menachem M. Weiner, MD
To the Editor:
There is a growing interest in minimally invasive and transcatheter mitral surgery to treat degenerative mitral disease. One such technique entails the use of sternal sparing mini-thoracotomy and transcatheter beating heart targeted NeoChord resuspension under echo guidance (NeoChord DS1000, St. Louis Park, MN).1, 2 However, the procedure does require a mini-thoracotomy, which can result in significant postoperative pain.3 As such, we performed serratus anterior plane block (SAPB) as part of a multimodal pain management strategy in 3 consecutive patients undergoing minimally invasive NeoChord mitral valve repair. All 3 patients (ages 61, 57, and 62 years) were deemed high-risk for conventional mitral valve repair owing to comorbid conditions. After endotracheal intubation, the SAPB was performed on the left side under ultrasound guidance (SonoSite S-Nerve ultrasound system fitted with a L38 × 10-5 MHz transducer, SonoSite, Inc, Bothell, WA). The ultrasound probe was placed in a sagittal plane at the midaxillary T3-4 level. The probe was moved medially until the latissimus dorsi and serratus anterior muscle planes were identified overlying the fourth and fifth ribs. Using an in-plane technique with a 22-gauge, 50-mm SonoPlex Stim needle (Pajunk Medical Systems, Tucker, GA), 30 mL of 0.25% bupivacaine was deposited between the latissimus dorsi and serratus anterior muscle plane from a caudal to cranial direction (Fig 1, A).4 Surgical access to the left ventricular apex was achieved with an incision (4-5 cm) in the fifth intercostal space just lateral to the midclavicular line, which corresponds to the T5-T6 dermatomes (Fig 1, B). After full heparinization, apical ventriculotomy was created, and the NeoChord system was deployed.
Serratus Anterior Plane Block for Transapical Off-Pump Mitral Valve Repair With NeoChord Implantation.Himani V. Bhatt, DO, Morgan L. Montgomery, MD, Alexander J.C. Mittnacht, MD, Ali Shariat, MD, Ahmed El-Eshmawi, MD, David H. Adams, MD, Menachem M. Weiner, MD
Mitral valve repair for severe mitral valve regurgitation during left ventricular assist device implantation.Amit Pawale, MD, Shinobu Itagaki, MD, Aditya Parikh, MD, Sean P. Pinney, MD, David H.Adams, MD, Anelechi C. Anyanwu, MD
Reply: Off-Pump Surgeons' Experience Is Paramount to Delivering High-Quality CABG Outcomes: But What Constitutes Experience?Joanna Chikwe, MD, Timothy Lee, MD, Shinobu Itagaki, MD, David H. Adams, MD, Natalia N. Egorova, PhD
Correlation of 2-Dimensional and 3-Dimensional Echocardiographic Analysis to Surgical Measurements of the Tricuspid Valve Annular Diameter.Himani V. Bhatt, DO, MPA, FASE, FASA, John Spivack, PhD, Pritul R. Patel, MD, Ahmed El-Eshmawi, MD, Yasmin Amir, BS, David H. Adams, MD, Gregory W. Fischer, MD, FASA