Perioperative management in minimally invasive coronary surgery

Objective: It is important to apply the same rules used for classical coron ary revascularization to beating heart coronary surgery. The surgeons must have a strategy, and be prepared for adverse events, and complications. Met hods: A careful analysis of the coronarography is essential to predict even tual contraindications or causes of possible operative difficulties. All th e team must be involved in the surgical protocol. Three main problems need to be solved: the prevention of ischemia during the procedure, good stabili zation of the anastomotic site and arterial occlusion. The first goal is re ached by using a pre-conditioning technique or an intracoronary shunt. Vess el stabilization may be obtained by several methods: pressure adhesion devi ces, patch technique or suction devices. The final problem is to have a blo od free field, this requires arterial occlusion which may be achieved in se veral ways: silastic Snares or sutures, aclan clamps, coronary occluder. Re sults: We have developed at la Pitie a protocol to apply all these principl es. From February 1997 to November 1998, multiple revascularization was per formed on 167 patients. A total of 344 coronary anastomosis were carried ou t (mean: 2.05 graft/patient). Conclusion: Some simple rules had to be appli ed to reduce the rate of complications to the minimum: a good clinical case selection, use of a routine protocol, and recognize the need to adapt the indications to the learning curve of the operator. (C) 1999 Elsevier Scienc e B.V. All rights reserved.