Patient has coronary artery bypass surgery while awake
A 51 year old man has undergone a coronary artery bypass
graft while awake, marking the
first time in the United States that
such surgery has been performed
without general anaesthesia.
The operation took place at
the Veterans Administration Hospital in Pittsburgh, Pennsylvania,
and was led by Dr Marco Zenati,
an assistant professor of surgery at
the University of Pittsburgh Medical Center, with the help of
anaesthesiologist Dr Juhan Paiste.
A 51 year old patient underwent heart surgery while awake 15983 (JUSTIN DUMOUCHEL FOR MARCO ZENATI MD.)
Dr Paiste used a combination
of epidural anaesthesia, sedatives,
and local anaesthesia to numb
the chest wall and control pain.
The patient, a professional magician, was alert and verbally interactive throughout the procedure.
Epidural anaesthesia was first
used for a coronary artery
bypass graft operation in 1998
by Dr Haldun Karagoz of Guven
Hospital in Ankara, Turkey. To
date, 31 patients have had such
surgery under epidural control.
The technique of minimally
invasive direct coronary artery
bypass grafting was also used in
the Pittsburgh operation. Minimally invasive bypass grafting is
a relatively new technique and
was pioneered at the University
of Pittsburgh Medical Center in
1995.
About 500 minimally invasive
bypasses have been performed
so far. Unlike conventional
bypass grafting, the procedure is
performed on a beating heart. It
thus avoids cardioplegia and use
of a heart-lung machine.
Also, a smaller thoracic incision is made in minimally invasive surgery rather than the median sterniotomy used in traditional bypass grafting. It is generally a less expensive procedure
than traditional bypass since a
heart-lung machine isn't used.
However, the procedure is
necessarily more delicate than
traditional bypass grafting
because the surgical working
field is much smaller and the
anastomosis is therefore more
difficult to achieve. Also, because
the procedure is performed on a
beating heart, the risk of bleeding
is greater and the heart has to be
restrained mechanically.
Dr Marco Zenati, who led the surgical team (UNIVERSITY OF PITSBURGH MEDICAL CENTER)
The Pittsburgh team envisages combining the techniques
of epidural anaesthesia and minimally invasive cardiac surgery
routinely and hopes to make the
combination a viable alternative
to angioplasty and, eventually,
an outpatient procedure.
Deborah Josefson, San Francisco
studentBMJ 2000;08:259-302 August ISSN 0966-6494
