Operative technique

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From September 1968 to June 1977, at the Dante Pazzanese State Institute of Cardiology in São Paulo, Brazil, 3264 patients underwent aortocoronary bypass graft surgery.

Table 1 shows the total number of patients, the number of grafts, and related mortality. The hospital mortality for the entire group was 5.6%. The inverted saphenous vein has been used 6536 times, and the internal mammary artery 479 times. There were no significant differences in mortality related to the number of grafts.

All patients were operated on with the aid of extracorporeal circulation, using an original nondisposable bubble oxygenator and moderate hypothermia. We do all the anastomoses in anoxic cardiac arrest by cross-clamping the ascending aorta as distally as possible. The decompression of the left chambers is done through a small longitudinal aortotomy just proximal to the clamp. Between each individual anastomosis the air is eliminated, the aortotomy is occluded, and the coronary circulation reestablished by opening the aortic clamp. The time of cross-clamping is almost always less than 15 minutes for distal anastomosis and less than 8 minutes for proximal anastomosis.

The proximal anastomosis is performed using three interrupted sutures at each corner and a continuous running suture from each end to the middle on both sides. The suture is done with Prolene 6-0 or 7-0. With anoxic arrest, there is no need for any special measure to control bleeding from the arteriotomy. Thus, the operating field is clear and quiet, making suturing easier. We believe that the clamping of the coronary or . . .



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