INTRAOPERATIVE MANAGEMENT AND OUTCOMES IN THORACOSCOPIC RADIOFREQUENCY EPICARDIAL ABLATION OF THE LEFT ATRIUM

• Published in: Journal of cardiothoracic and vascular anesthesia 2024-12, Vol.38 (12), p.12-13
• Main Authors: Marei, Ilia, Klypa, Tatyana, Mandel, Irina, Zotov, Alexander
• Format: Article
• Language: English
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2024.09.034

The clinical and laboratory features and perioperative characteristics of patients undergoing thoracoscopic radiofrequency epicardial ablation of the left atrium (TREALA) were investigated. The optimal anesthesiological approach for TREALA, ensuring patient stability was determined. This was a prospective study with retrospective control, analyzing a total of 187 patients undergoing planned TREALA. Preoperative demographics, clinical, laboratory, and instrumental data were collected. Central hemodynamic parameters, acid-base balance, and cerebral oximetry were monitored during surgery. Postoperative outcomes, including the need for non-invasive lung ventilation (NIV), intensive care unit (ICU) stay duration, and hemodynamic stability. Patients were divided into two groups based on the anesthesia technique employed. The control group used combined inhalation anesthesia (CIA), preferred for thoracoscopic interventions due to its lesser inflammatory response in the lungs, encompassing 51 patients (CIA group). The study group comprised 113 patients who received total intravenous anesthesia (TIVA) with mechanical ventilation, reflecting on the comparative advantages of this method (TIVA group). Results: The study cohort predominantly consisted of males (81.8%) with a median age of 60 years and a body mass index of 30 kg/m2. A significant enlargement of the left atrium by 14-38% and a reduction in the initial cardiac index by 5-30% were observed. The intraoperative phase was marked by patients positioned supine, alternating single-lung ventilation, and the presence of pleural cavity communications. Median bispectral index (BIS) values fluctuated in the CIA group across phases: 67% [63;78] (operation start) - 40% [32;51] (main phase) - 57% [46;65] (end of surgery), whereas BIS remained stable in the TIVA group. The required FiO2 to maintain optimal PaO2 and SatO2 levels was 80% [60;80] in the CIA group and 50% [45;70] in the TIVA group. Comparative analysis revealed a significant reduction in cerebral oxygenation (rSO2) during the main surgical phase: operation start phase rSO2 left 64% [56;71], right 61% [56;70], main phase rSO2 left 60% [52;66], right 61% [54;64], and end of surgery phase rSO2 left 66% [57;73], right 67% [56;72], with no significant difference between anesthesia types or between left and right sensor data. In the TIVA group, the cardiac index at the operation's outset was higher, with sympathomimetic support bringing cardiac index values back t