Minimally invasive cardiac surgery and transesophageal echocardiography

Jha, Ajay Kumar; Malik, Vishwas; Hote, Milind Padmakar

doi:10.4103/0971-9784.129844

Cited by 12 publications

(3 citation statements)

References 15 publications

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“…The role of TEE during MICS but carried out under CPB has been discussed by Jha et al . [ 6 ] Unlike the information provided by Jha et al ., the applications of TEE are different during MICS via subxiphoid approach. Most cardiac anesthesiologists are comfortable “seeing” the heart and monitoring it.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic implications of subxiphoid coronary artery bypass surgery

et al. 2016

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Background:Minimal invasive surgeries are carried out to benefit the patient with less pain, blood loss, mechanical ventilation and hospital stay; a smaller scar is not the aim. Minimal invasive cardiac surgeries are carried out via small sternotomy, small thoracotomy and via robotic arms. Subxiphoid route is a novel method and avoids sternotomy.Aim:This case series is an attempt to understand the anesthetic modifications required. Secondly, whether it is feasible to carry out subxiphoid coronary artery bypass surgery.Methods:Elective patients scheduled to undergo subxiphoid coronary artery bypass surgery were chosen. The surgeries were conducted under general anesthesia with left lung isolation via either endobronchial tube or bronchial blocker.Results:We conducted ten (seven males and 3 females) coronary artery bypass graft surgeries via subxiphoid technique. The mean EuroSCORE was 1.7 and the mean ejection fraction was 53.6. Eight patients underwent surgery via endobronchial tube, while, in the remaining two lung isolation was obtained using bronchial blocker. Mean blood loss intraoperatively was 300 ± 42 ml and postoperatively 2000 ± 95 ml. The pain score on the postoperative day ‘0’ was 4.3 ± 0.6 and 2.3 ± 0.7 on the day of discharge. Length of stay in the hospital was 4.8 ± 0.9 days. There were no complications, blood transfusions, conversion to cardiopulmonary bypass. The modifications in the anesthetic and surgical techniques are, use of left lung isolation using either endobronchial tube or bronchial blocker, increased duration for conduit harvesting, grafting, requirement of transesophageal echocardiography monitoring in addition to hemodynamic monitoring. Other minor requirements are transcutaneous pacing and defibrillator pads, a wedge under the chest to ‘lift’ up the chest, sparing right femoral artery and vein (to serve as vascular access) for an unlikely event of conversion to cardiopulmonary bypass. Any anesthesiologist wishing to start this technique must be aware of these modifications.Conclusions:Subxiphoid route is safe to carry out coronary artery bypass graft surgery using the minimal invasive cardiac surgery. It is reproducible and has undeniable benefits. We plan to conduct such surgeries in awake patients under thoracic epidural anesthesia thus making it even less invasive and amenable for fast tracking.

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Section: Discussionmentioning

confidence: 99%

Anesthetic implications of subxiphoid coronary artery bypass surgery

et al. 2016

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“…In general, the use of TEE is a well-established cornerstone in cardiac surgery [ 9 , 10 , 11 , 12 ], and it is very useful also outside of the cardiac surgery setting [ 13 ]. It must be emphasized that TEE has several merits in the setting of patients undergoing cardiac surgery, allowing for instance the evaluation of left ventricular systolic function and of right ventricular function, and also providing useful information for fluid management [ 14 ].…”

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confidence: 99%

Caution Is Warranted When Assessing Diastolic Function Using Transesophageal Echocardiography. Comment on Kyle et al. Consensus Defined Diastolic Dysfunction and Cardiac Postoperative Morbidity Score: A Prospective Observational Study. J. Clin. Med. 2021, 10, 5198

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et al. 2022

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“…This case reiterated the important and indispensable role of TEE in appropriate positioning of arterial and venous cannulae during minimally invasive cardiac surgery, other than its role in establishment of correct diagnosis, ruling out conditions that contraindicate this approach, detecting intraoperative problems that require immediate correction, allowing real-time assessment of valvular pathologies, ventricular filling and ventricular function, deairing, weaning from CPB, and the adequacy of the surgical procedure. [ 1 ]…”

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confidence: 99%