Operative technique for coronary bypass surgery

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Our current practice of myocardial revascularization is described herein. Standardization of operative technique is stressed and, although there are minor individual differences among our staff, these principles are followed routinely. Uncomplicated, elective patients are perfused with the 6 LF bubble oxygenator; however, the TMO membrane provides oxygenation for complex procedures such as reoperations, revascularization combined with valve repair, or replacement and multiple bypass grafting in patients with poor left ventricular function. Generally, perfusion is nor mother mic, except for high risk patients, reoperations, combined valve cases, and in unstable patients who require emergency revascularization. In these selected cases, systemic hypothermia and intermittent injection of a cardioplegic solution via the aortic root (or left coronary ostia in aortic valve cases) are used to enhance myocardial protection. Normotensive perfusion pressures are strictly maintained.

Blood conservation has been emphasized in the past 2 years. Foremost among these techniques are careful hemostasis and return of all sponge and oxygenator blood to the patient. In most patients a unit of blood can be withdrawn at the outset for transfusion postoperatively. During the operation hematocrit readings are kept in the 23% to 25% range in complex cases and 18% to 20% in routine procedures. In the Intensive Care Unit shed mediastinal and pleural blood is auto-transfused back to the patient. Utilizing these methods, transfusions have been reduced to approximately 1.5 units per patient on the average. Routine techniques for cannulation are as follows. The arterial perfusion cannula is inserted into the ascending aorta followed by superior . . .



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