Background: For severe mitral valve (MV) degenerative disease, repair is recommended. Prediction of repair complexity and referral to centers of excellence can increase rates of successful repair. This study sought to demonstrate that TEE is a feasible imaging modality to predict the surgical MV complexity score previously developed by Anyanwu et al. Methods: Two hundred TEE examinations of patients who underwent MV repair (2009 – 2011) were retrospectively reviewed and scored by two cardiac anesthesiologists. TEE scores were compared to surgical complexity scores of same subset of patients. Kappa values were reported for the agreement of TEE and surgical scores. McNemar’s tests were used to test the homogeneity of the marginal probabilities of different scoring categories. Results: TEE scores were slightly lower (2[1,3]) than surgical scores (3[1,4]). Agreement was 66% between the scoring methods, with a moderate kappa (0.46). Using surgical scores as the gold standard, 70%, 71% and 46% of simple, intermediate and complex surgical scores, respectively, were correctly scored by TEE. P1, P2, P3, and A2 prolapse were easiest to identify with TEE and had the highest agreement with surgical scoring (P1 agreement 79% with kappa 0.55, P2 96% (kappa 0.8), P3 77% (kappa 0.51), A2 88% (kappa 0.6)). The lowest agreement between the two scores occurred with A1 prolapse (kappa 0.05) and posteromedial commissure prolapse (kappa 0.14) (Figure 3). In the presence of significant disagreement, TEE scores were more likely to be of higher complexity than surgical. McNemar’s test was significant for prolapse of P1 (p=0.005), A1 (p=0.025), A2 (p=0.041), and the posteromedial commissure (p<.0001).

Introduction: Providing adequate analgesia during subcutaneous ICD implantation can be a challenge. The use of regional techniques such as erector spinae plane (ESP) block can provide both analgesia and attenuate the risk of opioid use especially in high-risk patient populations. Methods: This was a single center, prospective study of patients undergoing SICD implantation from February 2020 to February 2022. Patients were older than 18 years of age and randomly assigned to receive ESP block or traditional wound infiltration. The primary outcome was the overall use of perioperative analgesic medications in the ESP block versus the surgical wound infiltration group. Descriptive data are reported as count, mean, or median, as appropriate. For group comparisons, Fisher’s exact test was used for categorical variables; the student t-test was used for normally distributed continuous variables, and the Krustal-Wallis test was used for skewed continuous variables, as appropriate. Results: 24 patients were enrolled in the study. 11 patients received only wound infiltration and 13 patients received left ESP block. A significant reduction of intraoperative fentanyl use was observed in the ESP block. The overall postoperative day zero fentanyl use was also significantly decreased in the ESP group. The day to discharge was shorter in the ESP block group. Conclusion: This feasibility study showed that ESP block is both a safe and effective technique and demonstrated a significant decrease in intraoperative and postoperative opioid consumption that may be of clinical benefit in high risk patients. Larger studies are needed to further validate its use.