Technical Aspects of Anesthesia and Cardiopulmonary Bypass in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

ObjectiveThe use of fast-track general anesthesia in patients undergoing nonrobotically assisted and totally thoracoscopic cardiac surgeries has not been previously reported previously.DesignA prospective clinical study.SettingA university hospital.ParticipantsNinety-six patients (41 males; mean age, 13.2 ± 6.2 years; range, 5-47 years).InterventionNonrobotically assisted totally thoracoscopic surgeries were performed for atrial (n = 58) or ventricular septal defect (n = 32), tetralogy of Fallot (n = 2), left atrial myxoma (n = 3), and pulmonary valve stenosis (n = 1). Fast-track general anesthesia was induced with midazolam, propofol, fentanyl, and vecuronium and was maintained with remifentanil and sevoflurane. Cardiopulmonary bypass was established peripherally through the femoral vein and artery.Measurements and Main ResultsAll surgeries were successful. There were no perioperative mortality or major complications. The mean cardiopulmonary bypass and aortic cross-clamp times were 42 ± 21 minutes and 33 ± 8 minutes, respectively. In 82 cases, the heart regained beats automatically after the release of the aortic cross-clamp, whereas in 14 patients external defibrillation was required. Extubation was conducted in 32 patients (33.3%) in the operating room 15 minutes after the operation. The mean times of mechanical ventilation and stay in the intensive care unit were 1.5 ± 0.2 hours and 20.1 ±1.2 hours, respectively.ConclusionsCardiopulmonary bypass for totally thoracoscopic cardiac surgery can be established through the femoral artery and femoral vein. With fast-track anesthesia, early extubation in the operating room can be achieved in more than one third of patients.