Intra-operative care
During off-pump surgeries, stable hemodynamics are crucial. We opened the pericardium in an inverted-T fashion and added a vertical incision to the inferior surface to expand the pericardial cavity in the lateral dimension. This prevents right-side heart kinking when located in a standing position. We used phenylephrine as needed to maintain systemic blood pressure and excessive volume infusion was avoided where possible, to prevent post-operative edema or deterioration of oxygenation. Hemodynamics are monitored with Swan-Ganz catheter including pulmonary artery pressure, mixed venous oxygen saturation and cardiac output.
General anesthesia was maintained by inhaled anesthesia after anesthetic induction. As a muscle relaxant, rocuronium bromide was continuously infused at a specific dose according to the bodyweight of the patient, and was reversed with sugammadex when post-operative hemodynamic stability was confirmed.