Anesthetic Management for Minimally Invasive Cardiac Surgery

  • Julius Hamilton
  • Mark Caridi-ScheibleEmail author


The adoption of minimally invasive approaches to cardiac surgery allow for decreased perioperative morbidity without any change to the efficacy of therapy. A growing body of literature has demonstrated decreased ICU length of stay, decreased transfusion requirements and shortened hospitalizations without increases in short or long term mortality when compared to conventional approaches to cardiac surgery. Patient selection is of critical importance as these procedures are paired with increased procedural duration, longer aortic cross clamp times and increased technical difficulty. The use of a minimally invasive approach requires a careful analysis of risks and benefits and deciding factors should include the right procedure by the right surgeon for the right patient, not just a smaller incision.


Minimally invasive cardiac surgery (MICS) Totally endoscopic coronary artery bypass (TECAB) Minimally invasive coronary artery bypass (MIDCAB) Mini-aortic valve replacement Minimally invasive mitral valve surgery (MIMVS) 


  1. 1.
    Rosengart TK, Feldman T, Borger MA, Vassiliades TA, Gillinov AM, Hoercher KJ, et al. Percutaneous and minimally invasive valve procedures: a scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2008;117(13):1750–67.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Zenati M, Domit TM, Saul M, Gorcsan J, Katz WE, Hudson M, et al. Resource utilization for minimally invasive direct and standard coronary artery bypass grafting. Ann Thorac Surg. 1997;63(6 Suppl):S84–7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ganapathy S. Anaesthesia for minimally invasive cardiac surgery. Best Pract Res Clin Anaesthesiol. 2002;16(1):63–80.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chaney MA, Durazo-Arvizu RA, Fluder EM, Sawicki KJ, Nikolov MP, Blakeman BP, et al. Port-access minimally invasive cardiac surgery increases surgical complexity, increases operating room time, and facilitates early postoperative hospital discharge. Anesthesiology. 2000;92(6):1637–45.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ganapathy S. Thoracic epidural analgesia offers improved postoperative analgesa following midcab. Second meeting of ISMICS 1999.Google Scholar
  6. 6.
    Mihaljevic T, Gillinov M. Invited commentary. Ann Thorac Surg. 2012;93(5):1468.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Murkin JM, Boyd WD, Ganapathy S, Adams SJ, Peterson RC. Beating heart surgery: why expect less central nervous system morbidity? Ann Thorac Surg. 1999;68(4):1498–501.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Deshpande SP, Lehr E, Odonkor P, Bonatti JO, Kalangie M, Zimrin DA, et al. Anesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB). J Cardiothorac Vasc Anesth. 2013;27(3):586–99.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ito T, Maekawa A, Hoshino S, Hayashi Y. Right infraaxillary thoracotomy for minimally invasive aortic valve replacement. Ann Thorac Surg. 2013;96(2):715–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg. 1997;226(4):421–6; discussion 427–8CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    von Segesser LK, Westaby S, Pomar J, Loisance D, Groscurth P, Turina M. Less invasive aortic valve surgery: rationale and technique. Eur J Cardiothorac Surg. 1999;15(6):781–5.CrossRefGoogle Scholar
  12. 12.
    Moreno-Cabral RJ. Mini-T sternotomy for cardiac operations. J Thorac Cardiovasc Surg. 1997;113(4):810–1.CrossRefPubMedGoogle Scholar
  13. 13.
    Malaisrie SC, Barnhart GR, Farivar RS, Mehall J, Hummel B, Rodriguez E, et al. Current era minimally invasive aortic valve replacement: techniques and practice. J Thorac Cardiovasc Surg. 2014;147(1):6–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Brown ML, McKellar SH, Sundt TM, Schaff HV. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2009;137(3):670–679.e5.CrossRefPubMedGoogle Scholar
  15. 15.
    Khoshbin E, Prayaga S, Kinsella J, Sutherland FWH. Mini-sternotomy for aortic valve replacement reduces the length of stay in the cardiac intensive care unit: meta-analysis of randomised controlled trials. BMJ Open. 2011;1(2):e000266.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Neely R, et al. Minimally invasive aortic valve replacement versus aortic valve replacement through full sternotomy: the Brigham and Women’s Hospital experience. Ann Cardiothorac Surg. 2015;4(1):38–48. [cited 2017 Feb 13]. Scholar
  17. 17.
    Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. Less-invasive mitral valve operations: trends and outcomes from the society of thoracic surgeons adult cardiac surgery database. Ann Thorac Surg. 2010;90(5):1401–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2008;34(5):943–52.CrossRefPubMedGoogle Scholar
  19. 19.
    Glauber M, Miceli A, Canarutto D, Lio A, Murzi M, Gilmanov D, et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg. 2015;10:181. [cited 2017 Feb 13]. Scholar
  20. 20.
    Stevens L-M, Rodriguez E, Lehr EJ, Kindell LC, Nifong LW, Ferguson TB, et al. Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. Ann Thorac Surg. 2012;93(5):1462–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Cao C, Wolfenden H, Liou K, Pathan F, Gupta S, Nienaber TA, et al. A meta-analysis of robotic vs. conventional mitral valve surgery. Ann Cardiothorac Surg. 2015;4(4):305–14.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Murphy DA, Miller JS, Langford DA, Snyder AB. Endoscopic robotic mitral valve surgery. J Thorac Cardiovasc Surg. 2006;132(4):776–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Miller GS. Coronary sinus catheter placement in minimally invasive cardiac surgery: tricks, tactics, and tribulations. Lecture presented at Texas; 2017.Google Scholar
  24. 24.
    Cryer HG, Mavroudis C, Yu J, Roberts AM, Cué JI, Richardson JD, et al. Shock, transfusion, and pneumonectomy. Death is due to right heart failure and increased pulmonary vascular resistance. Ann Surg. 1990;212(2):197–201.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Emory University School of Medicine, Emory University HospitalAtlantaUSA
  2. 2.Department of AnesthesiologyEmory University School of MedicineAtlantaUSA

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