Intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting on the application of triangular-sail technique_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FU Yuanhao ¹ , GONG Yichen ¹ , QIAN Min ² , ZHANG Lufeng ¹ , ZHAO Hong ¹ ,  LING Yunpeng ¹

1. Department of Cardiac Surgery, Peking University Third Hospital, Beijing, 100191, P.R.China;
2. Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, P.R.China;

Corresponding author：

LING Yunpeng, Email: micsling@pku.edu.cn

Keywords：

Coronary artery bypass grafting; minimally invasive surgery; protective ventilation; two-lung ventilation

DOI：

10.7507/1007-4848.202101034

Video：

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Objective To analyze the feasibility of using triangular-sail technique that allows intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting (MICS CABG).Methods The clinical data of 207 patients with MICS CABG in our cardiac center from January 2019 to November 2020 were retrospectively analyzed. These patients were divided into two groups. A group OLV included 111 patients who underwent one-lung ventilation during surgery, while a group TLV included 96 patients who underwent intermittent two-lung ventilation. The triangular-sail technique was used in the group TLV. This simple technique isolated the operative field from lung lobes with the traction of pericardial adipose tissue. The preoperative data and perioperative clinical data of the two groups were compared and analyzed.Results There was no statistical difference in basic preoperative data between the two groups. The operation time in the OLV group was shorter than that in the TLV group (296.7±57.3 min vs. 334.1±87.0 min, P=0.000), and the duration of postoperative mechanical ventilation and ICU stay were not statistically different between the two groups. There was also no statistical difference in the incidence of pneumothorax or atelectasis between the two groups.Conclusion The triangular-sail technique is simple and easy to implement. The technique allows intermittent two-lung ventilation during MICS CABG procedure.

Citation： FU Yuanhao, GONG Yichen, QIAN Min, ZHANG Lufeng, ZHAO Hong, LING Yunpeng. Intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting on the application of triangular-sail technique. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 633-638. doi: 10.7507/1007-4848.202101034 Copy

1.	Thuijs DJFM, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet, 2019, 394(10206): 1325-1334.
2.	Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet, 2020, 395(10219): 191-199.
3.	McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: Dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
4.	Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
5.	Gong YC, Ling YP, Wu S, et al. Early clinical outcomes of minimally invasive coronary surgery-total arterial coronary revascularization. Zhonghua Yi Xue Za Zhi, 2019, 99(14): 1063-1068.
6.	Barsoum EA, Azab B, Shah N, et al. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg, 2015, 47(5): 862-867.
7.	Kiessling AH, Huneke P, Reyher C, et al. Risk factor analysis for fast track protocol failure. J Cardiothorac Surg, 2013, 8: 47.
8.	Ahonen J, Olkkola KT, Hynynen M, et al. Comparison of alfentanil, fentanyl and sufentanil for total intravenous anaesthesia with propofol in patients undergoing coronary artery bypass surgery. Br J Anaesth, 2000, 85(4): 533-540.
9.	Lin M, Shen Y, Wang H, et al. A comparison between two lung ventilation with CO₂artificial pneumothorax and one lung ventilation during thoracic phase of minimally invasive esophagectomy. J Thorac Dis, 2018, 10(3): 1912-1918.
10.	Sentürk NM, Dilek A, Camci E, et al. Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation. J Cardiothorac Vasc Anesth, 2005, 19(1): 71-75.
11.	Blank RS, Colquhoun DA, Durieux ME, et al. Management of one-lung ventilation: Impact of tidal volume on complications after thoracic surgery. Anesthesiology, 2016, 124(6): 1286-1295.
12.	Numa AH. Acute lung injury: Outcomes and new therapies. Paediatr Respir Rev, 2001, 2(1): 22-31.
13.	Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
14.	Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: Prediction, prevention, and treatment. Anesthesiology, 2009, 110(6): 1402-1411.
15.	Domino KB, Chen L, Alexander CM, et al. Time course and responses of sustained hypoxic pulmonary vasoconstriction in the dog. Anesthesiology, 1984, 60(6): 562-566.
16.	Slinger P, Triolet W, Wilson J. Improving arterial oxygenation during one-lung ventilation. Anesthesiology, 1988, 68(2): 291-295.
17.	Shimada M, Winchurch RA, Beloucif S, et al. Effect of anesthesia and surgery on plasma cytokine levels. J Crit Care, 1993, 8(2): 109-116.
18.	Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
19.	Cheng YL, Huang TW, Lee SC, et al. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anaesthesia in primary spontaneous pneumothorax. Respirology, 2010, 15(5): 855-859.
20.	Kim HY, Baek SH, Je HG, et al. Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol. J Thorac Dis, 2016, 8(5): 778-783.

1. Thuijs DJFM, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet, 2019, 394(10206): 1325-1334.
2. Holm NR, Mäkikallio T, Lindsay MM, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet, 2020, 395(10219): 191-199.
3. McGinn JT, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: Dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
4. Nambiar P, Kumar S, Mittal CM, et al. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg, 2018, 155(1): 190-197.
5. Gong YC, Ling YP, Wu S, et al. Early clinical outcomes of minimally invasive coronary surgery-total arterial coronary revascularization. Zhonghua Yi Xue Za Zhi, 2019, 99(14): 1063-1068.
6. Barsoum EA, Azab B, Shah N, et al. Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients). Eur J Cardiothorac Surg, 2015, 47(5): 862-867.
7. Kiessling AH, Huneke P, Reyher C, et al. Risk factor analysis for fast track protocol failure. J Cardiothorac Surg, 2013, 8: 47.
8. Ahonen J, Olkkola KT, Hynynen M, et al. Comparison of alfentanil, fentanyl and sufentanil for total intravenous anaesthesia with propofol in patients undergoing coronary artery bypass surgery. Br J Anaesth, 2000, 85(4): 533-540.
9. Lin M, Shen Y, Wang H, et al. A comparison between two lung ventilation with CO₂artificial pneumothorax and one lung ventilation during thoracic phase of minimally invasive esophagectomy. J Thorac Dis, 2018, 10(3): 1912-1918.
10. Sentürk NM, Dilek A, Camci E, et al. Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation. J Cardiothorac Vasc Anesth, 2005, 19(1): 71-75.
11. Blank RS, Colquhoun DA, Durieux ME, et al. Management of one-lung ventilation: Impact of tidal volume on complications after thoracic surgery. Anesthesiology, 2016, 124(6): 1286-1295.
12. Numa AH. Acute lung injury: Outcomes and new therapies. Paediatr Respir Rev, 2001, 2(1): 22-31.
13. Liu TJ, Shih MS, Lee WL, et al. Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery. Ann Thorac Surg, 2013, 96(1): 127-132.
14. Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: Prediction, prevention, and treatment. Anesthesiology, 2009, 110(6): 1402-1411.
15. Domino KB, Chen L, Alexander CM, et al. Time course and responses of sustained hypoxic pulmonary vasoconstriction in the dog. Anesthesiology, 1984, 60(6): 562-566.
16. Slinger P, Triolet W, Wilson J. Improving arterial oxygenation during one-lung ventilation. Anesthesiology, 1988, 68(2): 291-295.
17. Shimada M, Winchurch RA, Beloucif S, et al. Effect of anesthesia and surgery on plasma cytokine levels. J Crit Care, 1993, 8(2): 109-116.
18. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
19. Cheng YL, Huang TW, Lee SC, et al. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anaesthesia in primary spontaneous pneumothorax. Respirology, 2010, 15(5): 855-859.
20. Kim HY, Baek SH, Je HG, et al. Comparison of the single-lumen endotracheal tube and double-lumen endobronchial tube used in minimally invasive cardiac surgery for the fast track protocol. J Thorac Dis, 2016, 8(5): 778-783.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting on the application of triangular-sail technique

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