RT Book, Section
A1 Wasnick, John D.
A1 Hillel, Zak
A1 Kramer, David
A1 Littwin, Sanford
A1 Nicoara, Alina
SR Print(0)
ID 8551339
T1 Chapter 13. Off-Pump, Robotic, and Minimally Invasive Heart Surgery
T2 Cardiac Anesthesia and Transesophageal Echocardiography
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-171798-4
LK accessanesthesiology.mhmedical.com/content.aspx?aid=8551339
RD 2023/03/27
AB During  the  1990s  the  increased  use  of  angioplasty  and  the  development  of  stents  for  the  treatment  of  coronary  artery  disease  started  surgeons  on  a  quest  to  identify  new,  less  invasive  methods  of  treating  heart  disease.  Surgeons  attempted  to  perform  coronary  artery  bypass  through  keyhole-sized  incisions  assisted  by  thoracoscopic  techniques.1,2  Other  surgeons  attempted  to  use  robotic  surgery  to  reduce  surgical  incision  size.  Many  more  surgeons  simply  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—in  essence  operating  on  the  beating  heart.All  of  these  surgical  innovations  presented  challenges  for  anesthesiologists  at  one  time  or  another.  During  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  lifted  out  of  the  chest  and  potentially  rendered  ischemic  during  the  sewing  of  vascular  anastomoses.  Consequently,  the  off-pump  patient  can  deteriorate  acutely  requiring  resuscitative  measures  and  institution  of  emergency  CPB.  Never  should  off-pump  cases  be  considered  easy.