The history of cardiothoracic anesthesia at Cleveland Clinic begins in 1969 with the first saphenous vein aortocoronary bypass surgery performed by Dr. Rene Favaloro. Immediately following that landmark surgical achievement, the Section of Cardiothoracic Anesthesiology was established in October by Dr. John Viljoen. During the pioneering days of cardiothoracic surgery, Cleveland Clinic anesthesiologists monitored central venous pressure and left atrial pressure using water manometers, and the administration of intravenous nitroglycerin (produced by dissolving tablets in sterile water in the operating room) and nitroprusside, neither of which were available commercially.
With an increase in demand for bypass surgery and more cardiac surgery operating rooms, Cleveland Clinic's Board of Governors in 1970 granted Department status to Cardiothoracic Anesthesiology, and appointed Dr. Fawzy G. Estafanous as a first Chairman.
Cardiothoracic anesthesiology constantly evolves to parallel changes in cardiac surgery procedures, such as those for heart failure and complex valve procedures.
The Department of Cardiothoracic Anesthesiology is housed in state of the art facilities, which opened in October 2008. In 2010 we performed 4,100 cardiac procedures, including 750 isolated coronary artery bypass (CABG) surgeries, 70 ventricular assist device procedures, 54 heart transplants and 146 robotic mitral valve procedures. The balance of cases are combined CABG and/or valve and/or aortic procedures. Case complexity and acuity has continued to increase along with case volume.
Our group of 27 cardiothoracic anesthesiologists and 15 certified registered nurse anesthetists are involved in increasing numbers and types of “hybrid” cases that feature fluoroscopic and angiographic techniques which are helpful in confirming diagnoses and monitoring intraoperative results. The anesthesiologists involved with these cases are faced with the anesthetic implications related to remote monitor location, and technical challenges involving radiation, large fluoroscopy machines and confined space. Because the trend in cardiac surgery is to minimize the impact on the patient and to decrease the hospital stay, more novel and experimental procedures are introduced. For example, robotic surgery and transfemoral or transapical aortic valve replacement surgeries are becoming frequent. The majority of the cardiac procedures performed utilize intraoperative transesophageal echocardiography (TEE); that challenge is met by the Cardiothoracic Anesthesiologists who are certified in perioperative echocardiography and also receive advanced training in echocardiography through collaboration with the Department of Cardiology.
What does the future hold for the Department of Cardiothoracic Anesthesiology? With the increasing age of the general population, and the still remarkable prevalence of ischemic and valvular disease, the number of cardiac surgery cases will continue to grow. The number of cases is paralleled by increased complexity requiring a constantly evolving knowledge base and range of techniques. Minimally invasive and hybrid procedures require adaptability, an innovative spirit in clinical management, and are supported by evidence-based knowledge.
Center for Critical Care Medicine at the Heart & Vascular Institute
Preoperative Clinic (TCI)
Medical Director, Cardiovascular ICU
Aortic Surgery Anesthesia
Lung Transplantation Anesthesia
Percutaneous Transcatheter Procedures & Perioperative Transesophageal Echocardiography
Robotic Surgery Anesthesia
Ventricular Assist Devices & Heart Transplantation Anesthesia