Anaesthesia for Combined Cardiac and Thoracic Procedures

  • Marcin WąsowiczEmail author


Combined cardiac and thoracic procedures are rare; however thanks to progress of surgical techniques and recent advances in the use of extracorporeal life support (ECLS) techniques the number of these procedures is increasing.

Anaesthesia and optimal perioperative management for these complex, high-risk surgical interventions requires an expertise in both cardiac and pulmonary physiologies, lung isolation techniques, the multiorgan impact of cardiopulmonary bypass (CPB) and additional monitoring techniques (e.g. transesophageal echocardiography-TEE). Combined procedures may include excision of invasive tumours, pulmonary endarterectomy, cardiac revascularization combined with lung resection and cardiac procedures combined with lung transplantation (e.g. PFO closure). Optimal management of these procedures remains controversial and is not well described; in fact it is mainly limited to case reports (Marseu K et al. A A Case Rep 8:61–63, 2017; Slinger et al. Perioperative care in cardiac anaesthesia and surgery. Lippincott, Williams & Wilkins, Philadelphia/Baltimore/New York/London/Buenos Aires/Hong Kong/Sydney/Tokyo, 43–48, 2006). Proponents of single-stage operations will argue in favour of the avoidance of a second surgery and anaesthetic and reduced hospital stay (Slinger et al. Perioperative care in cardiac anesthesia and surgery. Lippincott, Williams & Wilkins, Philadelphia/Baltimore/New York/London/Buenos Aires/Hong Kong/Sydney/Tokyo, 43–48, 2006; Rao et al. Ann Thorac Surg 62:342-347, 1996). The opponents will argue for divided, two-stage procedures on the basis of limiting surgical trauma, blood loss, multiorgan impact of cardiopulmonary bypass and high intensive care morbidity and thus may potentially confer a better long-term survival (Rao et al. Ann Thorac Surg 62:342-347, 1996; Ciracio et al. Eur J Cardiothorac Surg 22:35–40, 2002).

The following chapter will briefly describe the anaesthetic management for various combined thoracic and cardiac procedures. For a better understanding of why CPB is detrimental for lung function, the author will briefly describe the structure and function of the air-blood barrier and pathophysiology of its injury during procedures with use of CPB.


Cardiac anaesthesia Thoracic anaesthesia Combined cardiothoracic surgery 

Supplementary material


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Authors and Affiliations

  1. 1.Department of Anesthesia and Pain ManagementToronto General Hospital, University Health Network and Department of Anesthesia University of TorontoTorontoCanada
  2. 2.Cardiovascular Intensive Care UnitToronto General HospitalTorontoCanada

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