Midcab

[drccw]

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MIDCAB- aka Minimally Invasive Direct Coronary Artery Bypass

anyone ever do one of these? When I was in residency it was a standard median sternotomy bypass (+/- the pump). I assume left thoracotomy, takedown of the lima and bypass. Double lumen tube? Typical length of surgery? Extubate in OR or fast track? TEP?

drccw

 

[Idiopathic]

one lung ventilation, the few that ive done we tried to get a paravertebral catheter in before extubation. I dont always agree with doing it post op but thats sort of the way its done.

 

[jennyboo]

When I did them, they were using DaVinci and taking the LIMA for single vessel bypasses (no pump). Surgeon wasn't exactly cranking them out but I wouldn't say he was slow either. He could fit two in a day with an hour or so left at the end of the day (includes looooong slow turnover, line placements, etc). I guess that makes it... 3-4 hours apiece?

We did DLT for left mini-thoracotomy, a-line, CVC (usually no PAC), no epidural (pretty small incision). Given the healthier nature of these patients (candidates for very simple minimally invasive single vessel bypass with good EF) we generally extubated in the OR.

A few takebacks for bleeding in the beginning -- but this got better over time. Takeback would just be a small open thoracotomy with DLT.