title: Coronary artery bypass grafting through complete sternotomy in conscious patients.
abstract: BACKGROUND
  Complete sternotomy is the standard approach in cardiac surgery, and coronary artery bypass grafting (CABG) is the most common revascularization procedure to use this approach. A new technique has been developed that permits complete surgical revascularization with arterial grafts in awake patients. This technique, which we refer to as awake coronary artery bypass grafting, avoids general anesthesia, mechanical ventilation, and extracorporeal circulation, thereby creating the least invasive method for heart operations yet described.
  
  
  METHODS
  A thoracic epidural catheter was placed at T2-T3 level one day before surgery. In 12 patients, single (n = 6), double (n = 5), or triple (n = 1) vessel coronary artery bypass grafting was performed without general anesthesia. In six patients, this procedure was performed after complete median sternotomy.
  
  
  RESULTS
  Ten patients remained awake throughout the whole procedure. Two patients required secondary intubation due to incomplete analgesia in one case and pneumothorax in the other. Procedural time was 98.2 +/- 19.8 minutes. Intermediate care stay was 4.9 +/- 0.6 hours. There were no perioperative complications, and early angiographic results before discharge were excellent in all patients.
  
  
  CONCLUSIONS
  The data presented show the feasibility and safety of complete surgical revascularization via median sternotomy using arterial grafts without general anesthesia. This approach shortens recovery time and increases patient comfort, suggesting that outpatient cardiac surgery may eventually be possible.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany. T.Aybek@em.uni-frankfurt.de
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Gerd
authors.initials: G
authors.lastname: Neidhart
authors.forename: Paul
authors.initials: P
authors.lastname: Kessler
authors.forename: Georg
authors.initials: G
authors.lastname: Matheis
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D003243:Consciousness; D001026:Coronary Artery Bypass / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy