New surgical techniques: implications for the cardiac anesthesiologist: mini-thoracotomy for coronary revascularization without cardiopulmonary bypass.

Minimally invasive coronary artery revascularization is a new technique in cardiac surgery of interest to both the medical profession and the general public. Although surgical methods are still evolving, two general approaches are used. The most prevalent technique is bypass of the left anterior descending coronary artery with the left internal mammary artery through a short left parasternal incision. Operation is performed on the beating heart under direct vision without the aid of cardiopulmonary bypass. The procedure is termed "minimally invasive direct vision coronary artery bypass (MIDCAB)". The second general approach is videoscopic, with multiple ports for exposure and manipulation. This method employs cardiopulmonary bypass and is more time-consuming than MIDCAB. These novel techniques raise new challenges for cardiac surgeons and anesthesiologists. An important goal of minimally invasive revascularization is to reduce pain and length of hospitalization and hence provide an attractive alternative to catheter techniques, in terms of both cost and patient acceptance. This report describes current protocols for patient selection and perioperative anesthetic management, along with early results in the use of this technique.