Twenty patients will undergo cardiac surgery while awake
PITTSBURGH, Sept. 18 -- The University of Pittsburgh Medical Center (UPMC) has just launched a study to determine if there are advantages of performing minimally invasive direct coronary bypass (MIDCAB) in patients without general anesthesia. It is believed to be the first such study to evaluate the feasibility, safety and potential benefits of using a chest-numbing epidural, like that used in child delivery, whereby patients would remain awake during surgery.
The UPMC research team includes the cardiac surgeon and anesthesiologist, who on June 15 of this year, performed the United States' first cardiac procedure in an awake patient. Marco Zenati, M.D., assistant professor of surgery at the University of Pittsburgh School of Medicine and director of the Minimally Invasive Cardiac Program at UPMC, and Juhan Paiste, M.D., assistant professor of anesthesiology and critical care medicine at the University of Pittsburgh, performed MIDCAB in an awake 51-year-old man at the VA Pittsburgh Healthcare System.
"While the patient tolerated the procedure well, this limited experience can only tell us so much. The possible benefits of this procedure are better pain relief and earlier awakening after the operation. And, by not having to place a tube in the patient's throat, which is required for general anesthesia, we could avoid pain and possible injury. But none of these potential benefits has been proven. We hope this study will provide some important insights," said Dr. Zenati, who is the study's co-principal investigator.
MIDCAB, also called beating-heart bypass surgery because no heart-lung machine is used, offers several advantages compared to standard cardiac bypass surgery, including a much smaller incision, a reduced risk of neurological complications and a shorter hospital stay. However, patients still must deal with the effects of general anesthesia, require a tube to be placed down the trachea and can expect at least one night in an intensive care unit as part of their hospitalization. With the patient awake, the UPMC researchers believe the procedure would be more tolerable and comfortable for the patient, perhaps on par with the less invasive angioplasty technique, with the added long-term benefits that bypass surgery affords.
The study will involve 20 patients undergoing MIDCAB who will have an epidural anesthetic delivered to the upper back, numbing the entire upper body and preventing the sensation of pain.
"Patients will remain awake, but if they feel anxious, we can administer medication intravenously to keep them comfortable," said co-principal investigator John P. Williams, M.D., associate professor of anesthesiology and critical care medicine at the University of Pittsburgh School of Medicine, and chief of anesthesiology at UPMC Presbyterian Hospital, where the study will take place. "While this type of anesthesia has seldom been used for MIDCAB procedures, we are actually quite experienced using the thoracic epidural for post-operative pain control after chest surgery," Dr. Williams added.
The anesthesiologist will monitor the patient's breathing and mental status throughout the surgery. If for any reason the surgeon or anesthesiologist feels that general anesthesia is warranted, the change can easily be administered.
Patients with coronary artery disease who are deemed appropriate candidates for MIDCAB and who meet other eligibility criteria will be considered for the study. Only patients able and willing to provide informed written consent may participate.
"This collaborative study with our anesthesiology colleagues is an extremely important one as we look for ways to make heart bypass surgery safer and more cost-effective for our patients," said Bartley P. Griffith, M.D., a co-investigator, chief of cardiothoracic surgery and the Henry T. Bahnson professor of surgery.
Other investigators include, from the department of anesthesiology and critical care medicine: John Caldwell, M.D.; Mark Hudson, M.D.; Teresa Gelzenis, M.D.: Joseph Quinlan, M.D.; and Erin Sullivan, M.D.
CONTACT:
Lisa Rossi
Frank Raczkiewicz
PHONE: (412) 624-2607
FAX: (412) 624-3184
E-MAIL:
RossiL@msx.upmc.edu
raczkiewiczfa@msx.upmc.edu