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shim shim shim shim shim shim shim shim shim Anesthesia for minimally invasive cardiac surgery: made ridiculously simple by art wallace, m. D. , ph. D. Anesthesia for minimally invasive cardiac surgery: mid-cabg i guess the first question should be what to call this new operation. It is minimally invasive cabg or minimal access cabg. Maximally difficult cabg. I don't know. A little cabbage is commonly known as a brussel sprout. Unfortunately, my affection for this operation parrallels my affection for little cabbage testicles as we called them as a child. There are several ideas about what this operation is all about. There is the heart port operation. The idea of the heart port system is to avoid that nasty sternotomy scar. An arterial inflow cannula is placed in a femoral artery and the venous outflow is placed through a femoral vein. A catheter with a balloon is advanced up the aorta and the balloon inflated in the ascending aortic arch. Aortic atherosclerotic disease is a definite contraindication for this operation. Picture sliding the catheter up a severely diseased aorta followed by retrograde perfusion from the groin. Cardioplegia is then delivered antegrade to the coronary arteries which have been separated from the systemic circulation by the ascending aortic arch balloon. A catheter is advanced from the internal jugular vein into the pulmonary artery for venting the left ventricle. The patient is placed on fem-fem bypass and cardioplegia established. A single vessel cabg is then performed either through a mini thoracotomy or thoracoscopically. The problem with this operation is simple. The risk from with a cabg is the extracorporeal circulation not the sternotomy. One of the major morbidities of cabg surgery is the neuropsychiatric changes and strokes. The heart port operation has a long bypass run for a single vessel cabg. It maximizes the risk of stroke while eliminating the sternotomy. Cts (chuck taylor surgical or cardio thoracic surgical) and us surgical have worked to improve the technique popularized by bennetti. blue viagra pill 100 viagra dosage and frequency It is in essence a mini-thoracotomy with no bypass. The standard is a single ima to the lad. The heart is stabalized by placing latex sutures under the lad proximal and distal to the site of the anastamosis. A small foot presses on the myocardium while the sutures pull the heart into the foot. Blood flow is stopped in the target vessel by the stabalizing sutures. The technique requires improved technical skill on the part of the surgeon in that the heart is moving (contraction as well as respiratory movement). It also requires increased technical skill on the part of the anesthesiologist because an area of myocardium is ischemic, and non -functional, and prone to reperfusion arrythmias. The advantage of the operation is reduced cost (no extracorporeal circulation, reduced hospitalization time) and reduced risk of stroke (no extracorporeal circulation). If surgeons and anesthesiologists. shim
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