Minimally invasive direct coronary artery bypass grafting: Changes in anesthetic management and surgical procedure

Objective:The authors hypothesized that changes in surgical procedures for minimally invasive direct coronary artery bypass grafting (MIDCAB) have led to changes in anesthetic management with a resultant decrease in the complexity of care. Design: Retrospective observational study. Setting: University teaching hospital. Participants: Review of the records of 60 patients who underwent MIDCAB surgery. Measurements and Main Results: Data included preoperative demographics, perioperative anesthetic management, and postoperative cardiac and noncardiac issues and complications. Two groups were formed: in group I, a coronary stabilizer (CS) was not used, and in group II, it was. With the exception of a greater incidence of those with no preoperative comorbidities in group II (CS), there were no differences between the two groups with respect to demographics or preoperative variables. A surgical design called H-graft was used in a greater number of group II (CS) patients, whereas a direct anastomosis was performed in the majority of group I patients. Use of pharmacologically induced bradycardia/asystole has not been performed after the introduction of the CS. The use of central venous catheters (instead of pulmonary artery catheters) and single-lumen (v double-lumen) endotracheal tubes was greater in group II (CS) patients. Despite changes in intraoperative management, there was no significant change in the incidence of postoperative complications, intensive care unit stay, and hospital stay between groups I and II. New-onset atrial fibrillation was the most common postoperative complication (13 of 56 patients; 23%). Three of 24 patients (12.5%) who received intraoperative magnesium experienced atrial fibrillation compared with 10 of 32 patients (31%) who did not receive magnesium. Conclusions: The complexity of anesthetic technique has decreased since the onset of MIDCAB surgery. The decrease in complexity may be related to changes in surgical design and technology. Copyright (C) 1999 by W.B. Saunders Company.