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CARDIOVASCULAR ANESTHESIA

Segmental Myocardial Wall Motion During Minimally Invasive Coronary Artery Bypass Grafting Using Open and Endoscopic Surgical Techniques

S. Mierdl, MD^*, C. Byhahn, MD^*, V. Lischke, MD^*, T. Aybek, MD, G. Wimmer-Greinecker, MD, S. Dogan, MD, S. Viehmeyer^*, P. Kessler, MD^*, and Klaus Westphal, MD^*

*Department of Anesthesiology, Intensive Care Medicine and Pain Control, Department of Thoracic and Cardiovascular Surgery, J.W. Goethe-University Hospital, Frankfurt, Germany

Address correspondence and reprint requests to Klaus Westphal, MD, Department of Anesthesiology and Intensive Care Medicine, Katharina-Kasper-Kliniken, Richard-Wagner-Str. 14, D-60318 Frankfurt, Germany. Address e-Mail to klaus.westphal{at}em.uni-frankfurt.de.

Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO₂ insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures.