One of the main goals of modern cardiac surgery is to reduce surgical trauma. Therefore, intensive research has been conducted in recent years to further develop surgical measures. Out came the possibility of new approaches, developments in perfusion as well as in anesthesia. An overview of the current options.
An important part of the developments in cardiac surgery is the possibility to proceed as minimally invasive as possible. These methods have a great impact on the quality of the long-term results as well as the convalescence of the affected patients, explained Prof. Dr. med. Omer Dzemali, Zurich. The current standard median sternotomy approach provides access to the heart as well as to vessels near the heart, making it favorable for all cardiac surgeries. Usually, the sternum also heals stably two to three months. However, the disadvantages are obvious: not only that this method is cosmetically unflattering. The large wound area can cause severe pain after surgery. In addition, there is a risk of increased blood loss with impaired blood clotting, as well as infections and impaired bone healing, especially in patients with osteoporosis.
Therefore, partial upper sternotomy should be increasingly used for procedures such as root, ascending, and hemibow replacement or uncomplicated type A dissection. In valve replacement, cardiac tumors, atrial septal occlusion, or in rhythm surgery, right lateral minithoractomy can also be used. For example, left lateral minithoractomy is suitable ei transapical TAVI or Tendyne MKE.
Focus on perfusion
Perfusion is an important component of cardiac surgery, but it also presents many challenges. A high use of technology with a lot of foreign material carries the risk of complications. However, significant progress has been made in this area. The control and monitoring modules can not only query a range of different values, but also process and evaluate them online. Meanwhile, regional oxygen saturation, online blood gas monitoring, noninvasive continuous measurement of SAO2, SVO2 as well as Hb and monitoring of microbubble activity can be performed under treatment. In addition, the ECMO could be significantly downsized so that it can also be used mobile on site and is available for different transport options.
Fasttrack as a means of anesthesia
With the help of the Fasttrack, the majority of minimally invasive patients can be treated in cardiac surgery. This includes administration of low-dose opioid-based anesthetics and early extubation. About 80% of patients are extubated while still in the operating room and then transferred to the intensive care unit. Rapid mobilization also shortens the time spent in the ICU, allowing patients to move more quickly to the normal ward and also reducing the overall length of observation. The economic benefit is in both finances and resources, the expert summarized.
Teamwork can also prevent complications. These include temperature management, intraoperative fluid and volume management, transfusion and coagulation management, postoperative analgesia, and delirium prevention.
Interdisciplinary collaboration becomes more important
Psychocardiology is a new discipline that is also becoming increasingly important in hospitals. The goal is to professionalize psychological care for patients. This includes, for example, pre- and post-operative psychocardiological care for those affected. A research project will detect the understanding of the relationship between psychological factors and cardiac surgical outcome, identify psychological risk factors, and build a detailed understanding regarding mediating mechanisms.
Congress: FomF Cardiology Update Refresher
CARDIOVASC 2022; 21(1): 31
