Minimally invasive cardiac surgery: surgical techniques and anaesthetic management

Objective: To review current data on minimally invasive cardiac surgery. Data sources: Search through the Medline(R) data base of French or English articles. Data extraction: The articles were analysed to make a synthesis of the vari ous techniques with their main indications and contra-indications. Data synthesis: Minimally invasive cardiac surgery includes various surgica l procedures. The usual techniques are described, their major benefits and drawbacks are discussed. The main goals of anaesthetic management are prese rvation of ventricular function and systemic perfusion, detection and treat ment of myocardial ischaemia, prevention of hypothermia in case of coronary artery bypass grafting on the beating heart via sternotomy, intermittent s elective ventilation of the collapsed lung using CPAP in case of limited th oracotomy. Expertise in transoesophageal echocardiography is essential for insertion and checking the accurate positionning of the various catheters o f the endovascular CPB Heartport(TM) system (pulmonary vent, endosinus cath eter, venous cannula, endoaortic clamp) allowing coronary artery bypass gra fting and mitral valve surgery through limited thoracotomy and finally, det ection of retained intracardiac air and assessment of complete clearing of cardiac cavities after mitral valve surgery through limited thoracotomy and aortic valve surgery via ministernotomy. Short-acting anaesthetic agents a llow rapid recovery from anaesthesia, early extubation and discharge to the surgical ward within 24 h, whereas overall time spent in the operating roo m is often longer than with conventional cardiac surgery. (C) 1999 Elsevier , Paris.