Sternotomy. Leave pericardium closed. Mammary retractor. Long hook superiorly, short hook inferiorly. Place operator-side blade first, long hook next and short hook last (or short hook on the left to be latched first, open a bit, then the long hook.) Keep the hooks as far apart as possible. The skin incision edge is protected from…

Blows on the lungs. Flow down, head down, Xclamp off, flow back up. Cross-clamp off and partially clamped just distal to the root vent to allow any air to be collected in a pocket there and sucked out. Apply pacing wires. Pace. To Anaesthetist/Perfusionist: Ventilating, Gases ok, Warm. Self: ECG (Rate, Rhythm, ST), Surgical site bleeding,…

Sternotomy. Sellors retractor. Pericardiotomy. Roberts clamp on operator side of pericardium. Apply Cosgrove retractor. Purse-strings to aorta, RA, IVC. Divide the lines. Cannulate AA, RA-SVC, IVC. Antegrade cardioplegia/vent. X-clamp. Cardioplegia (1.2l). Divide behind Sondergaard’s groove, and around the SVC (taking care to not injure the phrenic nerve). The line of division is obliquely starting supero-anteriorly…

Pre-op Control BP with GTN and labetolol (50mg bolus with 5% glucose, 2mg/min) 6u blood, FFP, platelets X-match. Right radial and right femoral arterial lines to monitor pressure. Bladder temperature probe. TOE. Operative procedure Prepare left femoral for cannulation. Give heparin. Cannulate. Secure at least 3 different locations. Femoral access – longitudinal incision over the…

The patient is positioned supine. Defibrillator paddles are placed on the sides of the chest. Prepping and draping to the knees.  CXR checked for height of mediastinum and sternum palpated to mark the intercostal spaces. Sternotomy Incision begins an inch lower than the jugular notch and goes up to the 3rd or 4th rib. If long…

Exposure Feel for the groove between the medial malleolus and tibialis anterior, just above the medial malleolus. Make a 1-2 inch incision in the line of the saphenous vein direction using the 22-blade. Use Mcindoe scissors to dissect and expose the vein. Insert the larger curved Mayo’s above the vein and create a tunnel travelling…

Thoracotomy may be described as posterior, postero-lateral, lateral, anterolateral and anterior. The patient is positioned on their contralateral side ensuring that the arm is flexed at the shoulder, drawing the scapula up the trunk is ‘broken’ at the subcostal margin with a sandbag and bent table. the knee and ankles are protected with jellybags to…

Fashioning the vein This is undertaken after checking for leaks, usually during initial cardioplegia delivery, or just before going on bypass. The proximal end of the vein is held between the left thumb and index finger. Cut the vein end obliquely to make a rhombus-hood using a Mcindoe scissors. Ensure the edges are clean off adventitia.…

Ingredients Mayo vein stripper 11-blade scalpel Artery forceps Ties Ligaclips   Technique Make an incision in the groin to find the saphenous vein. Ligate the vein. The distal part of the graft is tied off with a long tie. Insert the tied off distal part into the lumen of the Mayo vein stripper. Push it…