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.
Professor Ajit P. Yoganathan, PhD: "From bench to bedside": Celebrating his contributions to cardiac surgery with an honorary fellowship from the American Association for Thoracic SurgeryPedro Del Nido, MD, David H. Adams, MD
Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic ReviewSophia Alexis, Aaqib Malik, Ahmed El‐Eshmawi, Isaac George, Aditya Sengupta, Susheel Kodali, Rebecca Hahn, Omar Khalique, Syed Zaid, Mayra Guerrero, Vinayak Bapat, Martin Leon, David H. Adams, and Gilbert Tang
- Vincent Chauvette, MD, Maral Ouzounian, MD, Jennifer Chung, MD, Mark Peterson, MD, Munir Boodhwani, MD, Ismail El-Hamamsy, MD, François Dagenais, MD, Matthew Valdis, MD, Michael W A Chu, MD
- Vincent Chauvette, MD, Elbert E Williams, MD, Ismail El-Hamamsy, MD