Continuous Procedural Full-Lung Ventilation During Minimally Invasive Coronary Bypass Grafting

Background: In the past, minimally invasive cardiac surgery (MICS)- coronary artery bypass graft surgery (CABG) alternatives have been introduced that dramatically reduce the invasiveness of standard operative procedures while still showing excellent clinical outcomes. However, in patients with high morbidity, reduced lung function impeding single-lung ventilation is one of the major concerns for MICS-CABG procedures, although those patients might reap the largest benefit from a procedure of reduced invasiveness.

Methods: Here, we describe a simple surgical technique-the fan technique-that allows for continuous full-lung ventilation with unimpeded surgical view during common MICS-CABG procedures. To evaluate the procedural feasibility of this technique, we analyzed intraoperative ventilation measurements of 22 consecutive MICS-CABG patients in whom the fan technique was used.

Results: This study demonstrates a significant improvement of standard respiratory measurements during procedural full-lung ventilation using the fan technique as compared with conventional single-lung ventilation (ventilation pressure 21.4 ± 3.2 versus 26.6 ± 3 mbar, p < 0.001; respiratory rate 13.1 ± 1.4 versus 14.4 ± 2.2 breaths per minute, p < 0.001; minute volume 7.4 ± 1.1 versus 6.2 ± 1 L/min, p < 0.0001; Pao₂ during ventilation 294.9 ± 74.6 versus 153.2 ± 71 mm Hg, p < 0.0001).

Conclusions: The presented technique may not only enable us to perform MICS-CABG procedures in patients not suitable for single-lung ventilation owing to reduced pulmonary function, but also may soon also become a standard procedure for MICS-CABG surgery, especially with regard to procedures involving complex and time-consuming multivessel revascularizations. However, further studies are strongly warranted to assess whether the fan technique may also decrease postoperative pulmonary complications and benefit clinical outcome indicators.