Beating Heart Bypass Surgery and Minimally Invasive Conduit Harvesting: Cardiosurgical Techniques, Anesthesia Management

234 Pages·2004·4.48 MB·English

by  A. Diegeler (auth.)

V. GULIELMOS (ED.)
Beating Heart Bypass Surgery
and Minimally Invasive Conduit Harvesting
V. GULIELMOS (ED.)
Beating Heart
Bypass Surgery
and Minimally Invasive
Conduit Harvesting
I Cardiosurgical Techniques
I Anesthesia Management
With 38 Figures and 15 Tables
9
STEINKOPFF
DARMSTADT
Springer
Prof. Dr. Vassilios Gulielmos
Geniki Kliniki Thessaloniki
Gravias 2, Paraliaki Ave.
54645 Thessaloniki
Greece
ISBN 978-3-7985-1399-0 ISBN 978-3-7985-1929-9 (eBook)
DOI 10.1007/978-3-7985-1929-9
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Preface
The 1970s and 1980s were the "golden years" of cardiac sur
gery, as the surgeons were the only ones to offer an alternative
for the treatment of coronary artery disease. When catheter
based cardiovascular procedures appeared, not only did the
overallnumber ofcardiac interventions grow rapidly, but it also
established itself as the minimally invasive alternative. As a
consequence, the patient population for surgery started to
change as well. It was not until the 1990s when surgery, with
the introduction of less and minimally invasive techniques,
stimulated also by other specialties (e.g. OB/GYN, urology),
made a "come back". Various procedures in cardiac surgery
were on the way of being performed minimally invasively.
Whether it was valve replacements or repairs, septal defects,
the coronaries or even tumors, all were refined. In this book,
we focus on the minimally invasive coronary methods and all
direct or indirectly related techniques.
Establishing new methods always takes time; it needs the
pioneers and the early adopters to fine tune and bring them
into our daily routine. Nonetheless, industry plays an equal
role, with the pioneers on their side to bring the right devices
for the new techniques. While the surgical products for OPCAB
quickly became better and better, the adoption from the
surgical side was lagging behind. Therefore, the question be
came how to convince our colleagues to use this new method.
Exactlyat this point and initiated by an industry representative,
we started in Germany with "OPCAB Round Tables" where
VI I Preface
cardiac surgeons, anesthesiologists, cardiologists and perfusion
ists sat down with the industry to discuss the pro's and con's,
the strengths and possible improvements, and the needs for
OPCAB. After a fewof those events the idea was born to place
all of these ideas and "not yet" standards into a broader scope,
into the book you are now holding in your hands.
The today more or less mature version of the "novel" tech
niques are described in order to help new users of minimal
and less invasive cardiac surgery to avoid the mistakes and pit
falls already made and to help them start using it in the daily
routine. The techniques are faster, more effective, simple and
safe for the cardiac surgeon, but above all for our patients and
their families.
This book would not have been possible without all of my
colleagues and my scientific co-worker Ms Monika Weber
standing behind it and supporting it along the way. A special
thanks to Mr. Thomas Blauen who not only was instrumental
in initiating but also in coordinating the logistics of this project
along the way.
Thessaloniki (Greece),September 2003 VASSILIOS GULIELMOS
List of Contents
I Chapter 1:Introduction
Ahistorical review: From standardized coronary bypass
grafting to off-pump surgery. . .. . .. . . . .. .. ... .. ... 3
A.DIEGELER
What do weknow about OPCAB surgery
On-pump versus off-pump 11
I. FRIEDRICH, J.BORGERMANN
Systemicinflammatory response after cardiac surgery:
Is extracorporeal circulation the main culprit? 31
J.BORGERMANN, I. FRIEDRICH
I Chapter 2:OPCAB
Different stabilizer concepts and exposure techniques
for off-pump coronary artery bypass surgery 51
C. DETTER, T.DEuSE
Adjunct tools in OPCAB surgery . . . . . .. . .. ... . ... .. 62
I. FRIEDRICH, J.BORGERMANN
VIII I List ofContents
Monitoring and devices for hemodynamic assessment
during OPCAB 69
A.P.NIERICH, J.DAMEN
Anesthetic management 83
J.
NICOLAI
Atrial stimulation during OPCAB. Asimple maneuver
to maintain stable hemodynamics during OPCAB . . .. .. 93
V.GULIELMOS, U. KAPPERT, M. ELLER, H. SAHRE
Developing an OPCAB program 97
I. FRIEDRICH
Surgical techniques for off-pump coronary artery bypass
grafting .. ... . ... . .. . .. .. . .. ... . ... . .. . .. .. . .. 105
V.GULIELMOS, U.KAPPERT, M. ELLER, H. SAHRE,
J.
K. ALEXIOU, C. GEORGI, NICOLAI
OPCAB for multiple arterial revascularization . .. . .. . . . 115
J.E GUMMERT, J.-E LEGARE, EW. MOHR
I Chapter 3:MIDCAB
MIDCAB - anesthesia management . .. ... . .. . .. .. . .. 125
B. BEIN, P.H. TONNER
MIDCAB - small access bypass surgery 134
J.
CREMER, S. FRAUD
Minimally invasivedirect coronary artery bypass grafting
via partial inferior sternotomy 147
J.
K. HAKIM, BORGERMANN
Robotic-enhanced MIDCAB 159
C. DETTER, D. BOHM
List ofContents I IX
Off-pump totally endoscopic coronary artery bypass
grafting . . .. . . .. . .. ... . .. .. . . .. . .. . . .... ... . .. 170
u. J.
KAPPERT, SCHNEIDER, S.M. TUGTEKIN
I Chapter 4: Minimally Invasive Conduit Harvesting
Minimally invasive vein harvesting 187
I. SCHADE, B.LOWE
Minimally invasive vein harvesting -
video-assisted vein harvesting. .. . .. . . .. . .. .. . ... .. 195
R. COPPOOLSE, W. REES, M.G. MUNIPUTANNA,
D. OEFLER, H. WARNECKE
Minimally invasive video-assisted endoscopic
vein harvesting 204
A. KAPSALIS, K. ALEXIOU
Advancesin minimally invasiveharvesting
ofthe radial artery for coronary bypass grafting 214
U. ROSENDAHL
Endoscopic radial artery harvest 221
R.H. MILES, R.E. KOLLPAINTER
List of Contributors
Dr.BERTHOLD BEIN Dr.CHRISTIAN DETTER
DepartmentofAnaesthesiology Departmentof
and IntensiveCareMedicine Cardiovascular Surgery
University Hospital Kiel University Hospital
Schwanenweg21 Hamburg-Eppendorf
24105 Kiel Martinistr. 52
Germany 20246 Hamburg
Germany
Dr.JOCHEN BORGERMANN
Departmentof Cardiac Dr. ANNO DIEGELER
and Thoracic Surgery Departmentof Cardiac Surgery
Martin-Luther-University CardiovascularClinic
Halle-Wittenberg Salzburger Leite 1
Ernst-Grube-Str.40 97616 Bad Neustadt/Saale
06120 Halle/Saale Germany
Germany
Priv.-Doz.Dr.IVAR FRIEDRICH
Prof.Dr.JOCHEN CREMER Cardiothoracic Surgery
Departmentof Martin Luther University Halle
Cardiovascular Surgery 06097 Halle
Christian Albrecht University Germany
Arnold-Heller-Str, 7
24105 Kiel Prof. Dr.VASSILIOS GULIELMOS
Germany Geniki Kliniki Thessaloniki
Gravias 2,ParaliakiAve.
Dr.RUUD COPPOOLSE 54645 Thessaloniki
DepartmentofCardiac Surgery Greece
Schiichtermann-Klinik
Ulmenallee 11
49214 Bad Rothenfelde
Germany
XII I List ofContributors
Dr.JAN F.GUMMERT Dr.JOACHIM NICOLAI
Herzzentrum Leipzig Department of
Struempellstr.39 Cardiac Anesthesiology
04289Leipzig Heart Center Dresden
Germany University Hospital
Fetscherstr. 76
Dr.KAVOUS HAKIM 01307Dresden
Herzzentrum Coswig Germany
Lerchenfeld 1
06869Coswig Dr.ARNO NIERICH
Germany Isala Clinics
Department ofCardiothoracic
Dr. UTZ KAPPERT Anaesthesia & Intensive Care
DepartmentofCardiacSurgery Groot Wezenland 20
Heart Center Dresden 8000GMZwolle
University Hospital The Netherlands
Fetscherstr. 76
01307Dresden Dr.ULRICH ROSENDAHL
Germany DepartmentofCardiothoracic
and VascularSurgery
Dr.ANTHOS KAPSALIS Heart Center Lahr/Baden
DepartmentofCardiac Surgery Hohbergweg
Heart Center Dresden 77933Lahr
University Hospital Germany
Fetschertr.76
01307Dresden Dr.INA SCHADE
Germany DepartmentofCardiacSurgery
Heart Center Dresden
Dr.RONALD H. MILES University Hospital
Wausau Heart& LungSurgeons Fetscherstr.76
425Pine RidgeBlvd.,Suite 209 01307Dresden
Wausau,Wisconsin 54401 Germany
USA