TY - CHAP M1 - Book, Section TI - Off-Pump, Robotic, and Minimally Invasive Heart Surgery A1 - Wasnick, John D. A1 - Nicoara, Alina Y1 - 2019 N1 - T2 - Cardiac Anesthesia and Transesophageal Echocardiography, 2e AB - During the 1990s, cardiologists and surgeons began a quest to identify new, less invasive methods of treating heart disease. Angioplasty and stents were developed. Surgeons began to perform coronary artery bypass through keyhole-sized incisions assisted by thoracoscopic techniques.1,2 Subsequently, robotic surgery was introduced into the cardiac surgery operating room to further reduce surgical incision size. Some surgeons attributed most of the difficulties associated with cardiac surgery to the use of cardiopulmonary bypass (CPB). As such, they continued to operate on patients using a full sternotomy but completed their bypass grafts without the use of CPB operating off-pump on the beating heart.All minimally invasive surgical approaches present different potential challenges for anesthesiologists. During cardiac surgery with CPB, the surgical manipulations of the heart do not generally affect the patient’s hemodynamics—after all, the patient is on bypass. In the course of off-pump procedures, the heart must continue to beat and to supply blood to the tissues even when handled in the chest and potentially rendered ischemic during the sewing of vascular anastomoses. Consequently, the off-pump patient can deteriorate acutely requiring resuscitative measures and emergent institution of CPB. Anesthesiologists should never consider off-pump or minimally invasive procedures to be less demanding than those performed on-pump. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1166981259 ER -