The paper provides a historical and conceptual overview of anesthesia care for patients undergoing total revascularization without cardiopulmonary bypass (TROPCAB).
Historical overview informs TROPCAB anesthesia concepts; leaves open need for updated prospective data to guide practice.
The pioneers of cardiac surgery initially introduced the concept of myocardial revascularization, without the use of cardiopulmonary bypass (CPB). Vinberg attempted to increase the blood flow to the ischemic myocardium by implanting the internal mammary artery in the muscle mass of the left ventricle. 1 Sabiston performed his first coronary bypass by anastomosing the internal mammary to left anterior descending artery without using CPB. 2 However, the development and evolution of extracorporeal circulation techniques produced a motionless and bloodless field which most cardiothoracic surgeons felt was superior for performing coronary bypass grafting. The old concept of myocardial revascularization without CPB has recently gained an increasing interest among cardiac surgeons. Currently, TROPCAB refers to total revascularization by coronary bypass without the utilization of a cardiopulmonary bypass (CPB) machine or off-pump.
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