Opioid-Free Ultra-Fast-Track On-Pump Coronary Artery Bypass Grafting Using Erector Spinae Plane Catheters

Toward Opioid-Free Fast Track for Pediatric Congenital Cardiac Surgery

“…[1][2][3] The surgical exposure for minimally invasive mitral valve surgery (right anterolateral minithoracotomy) provides very limited access to the aorta and makes myocardial protection with antegrade cardioplegia challenging. 1,3 Early experiences used an endo-aortic balloon to administer antegrade cardioplegia, and retrograde cardioplegia was administered through a coronary sinus catheter. 3 The endo-aortic balloon approach was associated with complications such as aortic dissection and stroke and has fallen out of favor in some centers.…”

“…1,3 Early experiences used an endo-aortic balloon to administer antegrade cardioplegia, and retrograde cardioplegia was administered through a coronary sinus catheter. 3 The endo-aortic balloon approach was associated with complications such as aortic dissection and stroke and has fallen out of favor in some centers. [1][2][3] Direct cannulation of the ascending aorta and external aortic cross-clamp application to facilitate delivery of antegrade cardioplegia is another approach but can be technically challenging.…”

“…3 The endo-aortic balloon approach was associated with complications such as aortic dissection and stroke and has fallen out of favor in some centers. [1][2][3] Direct cannulation of the ascending aorta and external aortic cross-clamp application to facilitate delivery of antegrade cardioplegia is another approach but can be technically challenging. 1,3 Limited access to the ascending aorta during minimally invasive mitral valve surgery makes the use of retrograde cardioplegia alone a technique worth exploring.…”

“…[1][2][3] Direct cannulation of the ascending aorta and external aortic cross-clamp application to facilitate delivery of antegrade cardioplegia is another approach but can be technically challenging. 1,3 Limited access to the ascending aorta during minimally invasive mitral valve surgery makes the use of retrograde cardioplegia alone a technique worth exploring. In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Lebon et al retrospectively compare the use of combined antegrade and retrograde cardioplegia to retrograde cardioplegia alone in 215 patients who underwent minimally invasive mitral valve surgery.…”

“…In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Lebon et al retrospectively compare the use of combined antegrade and retrograde cardioplegia to retrograde cardioplegia alone in 215 patients who underwent minimally invasive mitral valve surgery. 3 Ninety-seven patients received retrograde cardioplegia alone, whereas 118 patients received combined antegrade and retrograde cardioplegia. The investigators observed that retrograde cardioplegia alone was associated with significantly shorter periods of cardiopulmonary bypass and aortic crossclamp application, less intraoperative bleeding, low volume of cardioplegia administered, and lower intraoperative lactate levels in comparison with combined antegrade and retrograde cardioplegia.…”