Cardiovascular Surgery CABG

Coronary Artery Bypass Graft

Objective

•   To open chest

•   To expose heart

•   To connect aorta to coronary artery (CA) with a vein or internal mammary artery so as to bypass block in CA. 

Position

Supine.

Anesthesia

General.

Procedure

   1.  Catheterization cleaning of chest and both legs.

   2.  Draping the chest and both legs. 

   3.  Skin incision with 20 No. blade saw and cable for sternotomy Finochietto retractor for sternum. 

   4.  Cautery for pericardiotomy pericardial retraction sutures 2/0 atro silk. 

   5.  Internal mammary artery or saphenous vein dissected after sternotomy if desired by surgeons. 

   6.  Saphenous vein graft is taken from the leg, graft check in heparanized saline. 

   7.  Bleeders tied with 4/0 silk hemostatic clips applied for hemostasis marking suture of 4/0 Surgilene is done on distal end. 

   8.  Thigh is closed with 0 Vicryl suture with 3/0 Surgilene.

   9.  Cannulation. 

10.  2-0 T2 is used for aortic purse string. No. 12 blade and No. 11 blade for incision on aorta, aortic cannula tie suture 2/0 atro silk. Connect the arterial line. 

11.  Becks clamp to clamp SVC and connect with arterial line. Incision with 12 No. blade purse string with 4/0 C2 Tevdek. SVC cannula is connected venous line. 

12.  Purse string with 4/0 T3 insertion of cardioplegia needle and 3 way connection. Ice cold ringer lactate. 

13.  Internal mammary artery or sephanous vein dissection. 

14.  Patient goes on bypass. Aorta is cross clamped. Cooling upto 27°C heart stop. Dissect the coronary vessel by Pott’s scissors. Distal end of saphenous vein 6/0 Proximal end of coronary artery with 6/0 prolene suture needle. 

15.  All the grafts are sutured to the aorta in same manner. 

16.  Pacing wire and BP heart rate. ECG maintained.

17.  Venous line clamp. Remove the cannulae and tie with silk. 

18.  Decannulation. 

19.  Aortic cannula is removed a stitch of 2-0 T2 is taken. 

20.  Sponge and instrument count. 

21.  Steel wires are used for sternum closure.

22.  Bandage the legs; elasto crepe bandage. 

23.  Dressing with betadine.

Instruments

•   Cleaning set 

•   Cardiac set 

•   Open heart special set 

•   Open heart vascular set 

•   Open heart water seal 

•   Coronary set.

Any questions be sent to drmmkapur@gmail.com  

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