Samata R Paidy

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Journals/Publications

• Ford, P., Cheung, A. R., Khan, M. S., Rollo, G., Paidy, S., Hutchinson, M., & Chaudhry, R. (2024). Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review. Journal of cardiothoracic and vascular anesthesia, 38(11), 2754-2760.
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  Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.
• Avery, R., Paidy, S. R., Keller, R., Lick, S., Smith, R. G., & Khalpey, Z. (2017). Tissue Expander as a Routine Component of 50cc Total Artificial Heart Implantation for Bridge to Transplant. Circulation. Heart failure, 10(1), e003765.
• Nielsen, V. G., Paidy, S. R., McLeod, W., Fox, A., & Nfonsam, V. N. (2017). Treatment of accidental perianal injection of topical thrombin with intravenous antithrombin. Journal of thrombosis and thrombolysis.
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  While topical thrombin application can markedly improve surgical hemostasis, rapid absorption of thrombin can result in pulmonary embolism and death. We report a case of accidental interstitial infiltration of topical thrombin after hemorrhoidectomy that was treated with administration of human antithrombin and heparin anticoagulation. Except for a marked decrease in antithrombin activity from super normal to normal values, the patient exhibited no laboratory or clinical signs of pulmonary embolism, thrombin mediated consumptive loss of procoagulants, or regional thrombosis. The patient had an uncomplicated recovery without sign of thrombotic morbidity. While it is hoped that such a medical misadventure should not occur, our case may serve as a reference to guide anticoagulant therapy if such a clinical scenario arises.
• Nielsen, V. G., Paidy, S. R., Meek, C. A., Thornton, T. K., & Lick, S. D. (2017). Survival after intravenous thrombin prior to cardiopulmonary bypass. International journal of legal medicine.
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  We present a case of a patient undergoing aortic valve replacement being inadvertently administered 5000 U of bovine thrombin instead of heparin for anticoagulation for cardiopulmonary bypass. The labeling error was made within the operating room pharmacy. The key to survival of this patient was a rapid diagnosis, administration of antithrombin and heparin, and removal of cardiac and great vessel thrombi. It is recommended that point of care anesthesia providers `prepare heparin for cardiopulmonary bypass anticoagulation, as thrombin is not used in anesthetic practice and is not contained within anesthesia cabinet medication drawers.
• Redford, D. T., Paidy, S. R., Steinbrenner, E. B., & Nielsen, V. G. (2016). Effects of profound hypoxemia on coagulation & fibrinolysis in normal individuals. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.
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  Hypoxia has been proposed to enhance, diminish, or have no effect on laboratory measures of coagulation or clinical thrombosis. Further, there usually are significant pathological or environmental factors concurrently present with hypoxia. Thus, the goal of the present investigation was to determine whether whole blood or plasmatic coagulation and fibrinolytic kinetics would change in response to progressive hypoxia to a systemic oxygenation (SpO2) of 70%. Healthy, conscious volunteers (n = 9) breathing a hypoxic mixture of gases during an in-vivo validation of noninvasive cerebral oximetry had blood samples collected and assessed with thrombelastography at normoxia and after SpO2 of 70%. A mild release of endogenous heparin-like activity occurred that diminished plasmatic coagulation, and a mild increase in clot lysis time also was noted. Further investigation to determine whether these phenomena occur in more chronic, less hypoxic states as sources of hypocoagulation or thrombophilia is needed.
• Khalpey, Z., Riaz, I. B., Marsh, K. M., Ansari, M. Z., Bilal, J., Cooper, A., Paidy, S., Schmitto, J. D., Smith, R., Friedman, M., Slepian, M. J., & Poston, R. (2015). Robotic Left Ventricular Assist Device Implantation Using Left Thoracotomy Approach in Patients with Previous Sternotomies. ASAIO journal (American Society for Artificial Internal Organs : 1992), 61(6), e44-6.
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  Left ventricular assist devices (LVADs) are commonly used as either a bridge-to-transplant or a destination therapy. The traditional approach for LVAD implantation is via median sternotomy, but many candidates for this procedure have a history of failed cardiac surgeries and previous sternotomy. Redo sternotomy increases the risk of heart surgery, particularly in the setting of advanced heart failure. Robotics facilitates a less invasive approach to LVAD implantation that circumvents some of the morbidity associated with a redo sternotomy. We compared the outcomes of all patients at our institution who underwent LVAD implantation via either a traditional sternotomy or using robotic assistance. The robotic cohort showed reduced resource utilization including length of hospital stay and use of blood products. As the appropriate candidates become elucidated, robotic assistance may improve the safety and cost-effectiveness of reoperative LVAD surgery.
• Khalpey, Z., Sydow, N., Paidy, S., Slepian, M. J., Friedman, M., Cooper, A., Marsh, K. M., Schmitto, J. D., & Poston, R. (2014). Robotic-assisted implantation of ventricular assist device after sternectomy and pectoralis muscle flap. ASAIO journal (American Society for Artificial Internal Organs : 1992), 60(6), 742-3.
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  Left ventricular assist devices are increasingly important in the management of advanced heart failure. Most patients who benefit from these devices have had some prior cardiac surgery, making implantation of higher risk. This is especially true in patients who have had prior pectoralis flap reconstruction after sternectomy for mediastinitis. We outline the course of such a patient, in whom the use of robotic assistance allowed for a less invasive device implantation approach with preservation of the flap for transplantation.
• Redford, D., Paidy, S., & Kashif, F. (2014). Absolute and trend accuracy of a new regional oximeter in healthy volunteers during controlled hypoxia. Anesthesia and analgesia, 119(6), 1315-9.
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  Traditional patient monitoring may not detect cerebral tissue hypoxia, and typical interventions may not improve tissue oxygenation. Therefore, monitoring cerebral tissue oxygen status with regional oximetry is being increasingly used by anesthesiologists and perfusionists during surgery. In this study, we evaluated absolute and trend accuracy of a new regional oximetry technology in healthy volunteers.

Presentations

• Paidy, S. (2024, March). OR Efficiency. Association of Clinical Directors. Scottsdale, AZ: Association of Clinical Directors.

Poster Presentations

• Paidy, S. R., & Smith, D. (2014, May). Intraoperative Transesophageal Echocardiogram for Confirming Diagnosis and Treatment of Pericardial Cyst.. Western Anesthesia Residence Conference. Seattle.