INTRODUCTION: Recently, a new direction in minimally invasive coronary surgery has become more and more active in the clinical practice of cardiac surgery. It is based on the beating-heart technology (if only the anterior descending artery is affected) without the use of heart-lung machine, or with the use of so-called MECC perfusion (in multivessel lesions) and the use of antero-lateral mini-thoracotomy. In this case, the harvesting of one or both internal thoracic arteries is performed completely endoscopically. The rehabilitation period with minimal invasive intervention is much less than after conventional CABG, less blood loss, significantly lower risk of postoperative infectious and other complications. The ability to perform complete myocardial revascularization without sternotomy allows patients with an extremely high comorbidity to be treated. For these patients the use of conventional approaches involves an extremely high risk of postoperative mortality. Transesophageal echocardiography (TE-ECHO) is a prerequisite for all stages of endoscopically assisted CABG.
OBJECTIVE: to evaluate the possibility of intraoperative TE-ECHO at the stages of endoscopically assisted CABG.
MATERIALS AND METHODS: 22 endoscopically assisted CABG were performed in A.V. Vishnevsky national research medical center in 2017-2018. Some of the surgical procedures were performed under the control of the intraoperative TE-ECHO.
RESULTS: All surgical interventions were successful. Bleeding and other surgical complications, as well as deaths in the postoperative period was not.
The postoperative in-hospital staying was 5.2 days.
Evaluation of the use of intraoperative TE-ECHO allowed the development of a methodology for its implementation and the development of an algorithm for the TE-ECHO controlled cardiac surgical manipulation.
Stages of performing TE-ECHO during endoscopically assisted CABG:
- Cannulation of the vein (allows to avoid damage of the hepatic and other visceral veins, damage of the right and also left auricles through PFO).
- Control of cardioplegia (presence of regurgitation flow through the aortic valve from the root of the aorta).
- The end of the perfusion (since direct visualization of the heart on-pump is practically impossible, the data of the TE-ECHO are the basis for assessing the adequacy of cardiac recovery and the main criterion in the selection of cardiotonic therapy in the postperfusion period).
CONCLUSION: TE-ECHO is important for endoscopically assisted CABG, allowing to avoid complications during the intervention stages, and also to assess the adequacy of its implementation.
