Intraoperative echocardiography for the patient undergoing minimally invasive heart surgery
Minimally invasive heart surgeries are commonly used to avoid large surgical incisions and facilitate early extubation and recovery after cardiac surgeries. Transesophageal echocardiography (TEE) is especially valuable in minimally invasive cardiac surgery because the inherently limited access to the thorax and mediastinum impairs direct visualization of the heart. TEE influences the clinical decision making process in several ways. Changes to the anesthetic management include alteration in volume loading in the presence of diastolic dysfunction or left ventricular outflow tract obstruction, as well as augmenting coronary perfusion pressure and implementing coronary vasodilators for new regional wall motion abnormalities. Changes to the surgical plans include replacement or repair for regurgitant valves, placement of intra-aortic balloon pumps for persistent regional wall motion abnormalities, and changing the surgical approach in the presence of severe aortic disease. Currently, two approaches are commonly used in minimally invasive cardiac surgery. The first approach, port-access minimally invasive cardiac surgery, continues to use cardiopulmonary bypass. This approach relies extensively on TEE to correctly place endovascular devices necessary for cardiopulmonary bypass in addition to routine assessment of cardiac function. The second approach, minimally invasive direct coronary artery bypass, involves performing the revascularization on a beating heart. Here, TEE is essential for assessment of ventricular function if ischemic preconditioning is used as a strategy for myocardial protection.
Han, LK; Jacobsohn, E; Aronson, S
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