#12. CORONARY ARTERY BYPASS

TITLE OF OPERATION: Coronary artery bypass.

DESCRIPTION OF PROCEDURE: After induction of general anesthesia, the patient was prepped and draped in the usual sterile fashion. A median sternotomy incision was made and hemostasis was acquired with the electrocautery. The left internal mammary artery was harvested and prepared with papaverine and concurrent saphenous vein was harvested endoscopically.
After heparinization, deep pericardial retraction sutures were placed. A partial clamp was then placed on the ascending aorta and the saphenous vein graft was sewn end-to-side with a running 6-0 Prolene. It was then allowed to distend under arterial pressure.
The heart was elevated out of the pericardial cavity and the diagonal was isolated with the octopus stabilizer. The anastomosis was then performed utilizing a side-to-side 8-0 running technique with the left internal mammary artery. The continuation of the left internal mammary artery was then placed end-to-side to the left anterior descending artery with a running 8-0 Prolene technique.
The heart was strongly elevated out of the pericardial cavity and the anastomosis of the saphenous vein graft to the obtuse marginal one was completed end-to-side with a running 7-0 Prolene. The heart was then allowed to return to the pericardial cavity and preparations for wound closure were made.
The pericardium was loosely approximated with interrupted silk sutures. The mediastinum was drained with a single Silastic tube. The sternum was approximated with interrupted heavy wire and the presternal fascia was closed with a running 0-PDS. The skin was closed with a subcuticular 3-0 Monocryl.
Sponge and needle counts were correct. The technical aspects of the procedure were satisfactory and it is hoped that the patient will have a good operative result.