Monitoring aspects during port-access cardiac surgery

Objective. To report the experience gained at our Cardiosurgical Centre wit h the recently introduced port-access technique. Methods. Experimental design: Prospective collection of data from the month of October 1997. Setting: Regional University Hospital Patients: Adult pat ients undergoing coronary bypass graft or mitral valve surgery. Interventio ns: Port-access technique makes it possible to carry out open-heart procedu res through a minithoracotomy and extrathoracic cardiopulmonary bypass with a set of properly designed catheters (Heartport EndoCPB(TM) system) for ca rdioplegia delivery and heart venting. Measures: Transesophageal echography and pressure traces are the main monitoring tools used for the correct pla cement of these catheters and for the clinical management of the patient. Results. Sixty-two cases have been performed so far. A complete description of the procedure, with monitoring aspects and problems encountered is thor oughly presented. Conclusions. The major differences with traditional cardiac surgery are tha t interruption of myocardial perfusion is not achieved through a transversa l clamp but through an endovascular occlusive balloon and that thoracic acc ess is by minithoracotomy. Unlike traditional open surgery, the surgeon has no direct vision of the position of the clamp and the anesthesiologist can not visually inspect the contractile state of the heart. The operative tea m has to cope with a multifaceted system of monitored variables that must b e continuously integrated and interpreted. Tight cooperation and continuous communication between anaesthesiologist, surgeons and perfusionist appear to be more important than in any other cardiac operation.