Article

Surgical techniques

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Abstract

Between January 1968 and September 1977, 1979 patients were operated on for coronary artery disease. This statistic is divided into five groups (Table 1). These groups are defined with regard to the pathologic specifications and the problems of surgical technique as well as the operative risk.

The surgical procedure is listed in Table 2. In the majority of cases, the bypass is achieved by way of a venous autotransplant, in general, saphenous. In a small number of cases, the internal mammary artery is anastomosed directly to the left anterior descending artery or the circumflex artery. A complementary coronary endarterectomy was performed in 21.8% of these cases.

Evolution

At the beginning of our experience, we performed mainly single bypasses on the right coronary artery. From 1969 the revascularization involved also the left anterior descending artery and the circumflex artery. As our surgical experience increased and the diagnoses became more precise, the character of myocardial revascularization became more and more complete, thanks to the increasing frequency of multiple bypasses.

There is no doubt that the concept of complete revascularization allowed us to enlarge indications in the cases of diffuse coronary artery disease as well as in the cases of bad left ventricle (Fig. 1).

Extracorporeal circulation

At present, extracorporeal circulation is performed in total hemodilution. Bubble oxygenators are commonly used for short extracorporeal circulations. We are using membrane oxygenators increasingly for long interventions involving complete revascularization by multiple anastomoses; these oxygenators guarantee a better extracorporeal circulation and the possibility of circulatory assistance, . . .


 

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