Port-Access Cardiac Surgery: Anesthetic Techniques, Equipment, Applications, Experience, and Outcomes

Abstract

Port-Access (Heartport, Inc, Redwood City, CA) mini mally invasive surgery has been developed to allow surgeons to complete a wide variety of cardiac surgical procedures while avoiding a median sternotomy and the associated trauma and debility. Cardiopulmonary bypass is established using the EndoDirect (Heartport, Inc) or EndoCPB systems which consist of five catheters and cannulae providing the same functions as those used in conventional cardiac surgery. These systems enable surgeons to obtain appropriate myocardial pro tection, circulatory support, and operating conditions while operating through a small intercostal incision or port. Transesophageal echocardiography and/or fluoros copy are used to evaluate patient anatomy including assessment of the aorta, to facilitate the placement of catheters and cannulae, and to monitor during the conduct of cardiopulmonary bypass. Clinical reports have shown broad applicability of Port-Access proce dures with favorable outcomes. Morbidity and mortal ity compare well with reported rates for conventional surgery. Experience with multivessel coronary artery bypass grafting suggests that complete revasculariza tion for all coronary beds can be accomplished using a variety of venous and arterial conduits. Clinical studies suggest that Port-Access surgery is associated with short postoperative duration of tracheal intubation, intensive care unit stay, and hospital stay, a low inci dence of new-onset atrial fibrillation, and rapid return to normal activities. Clinical experience continues to ex pand the indications for Port-Access minimally invasive cardiac surgery as well as to refine and enhance surgical procedures.