Special features of anesthesia in minimally invasive heart surgery

When heart-lung machines made extracorporeal circulation possible in the fi fties, cardiac surgeons gained virtually unrestricted access to the resting , motionless heart. Valve repair and reconstruction, in particular, made gr eat progress as a result of extra corporeal circulation. While the distinct advantages of extracorporeal circulation for cardiosurgery remain undisput ed, awareness of the significant perioperative risks of extracorporeal circ ulation for the patient has been increasing in recent years. This has lead to an interest in alternative cardiosurgical techniques avoiding extracorpo real circulation. Inspired by minimally-invasive procedures in abdominal su rgery, cardiosurgical instruments as well as surgical techniques of access to the heart and large thoracic vessels were systematically modified leadin g to today's minimally-invasive cardiosurgical procedures such as off-pump coronary artery bypass grafting on the bearing heart. Similarly, in the fie ld of cardiacvalve repair, new cannulation techniques for instituting extra corporeal circulation make median sternotomy unnecessary. The developments described above have lead to the recent introduction of robot-assisted tech niques with or without extracorporeal circulation,which are expected to mak e possible in the near future the performance of the whole range of cardios urgical procedures with minimal surgical trauma. The introduction of the new techniques has changed the intraoperative respo nsibilities of the anesthesiologist. The present article will therefore des cribe both the new surgical techniques as well as the new tasks required of the anesthesiologist, in particular with regard to cannulation and monitor ing. Since a number of terms in minimally-invasive cardiosurgery are not pr ecisely defined, a clear description of the various surgical techniques is also provided.