Indications Progressive RV impairment or RV dilatation with severe PR; severe PS; Consider TV annuloplasty if TR dilated. Redo sternotomy – RV/RA may be dilated and stuck to sternum. Expose Aorta (sling), SVC (snare if TV), IVC, (snare if TV), MPA. Take care not to injure LAD as it passes behind the PA, or the…
Open the pericardium to the right, so a piece of pericardium may be harvested if needed later to augment the SVC-PA anastomosis. Place stay sutures as usual. Start with the aorta (mosquito) and place a sling. Free the adventitia from the aorto-pulmonary area on the RPA and the LPA. Mobilise the PAs enough to get…
Before CPB Harvest the pericardium as a large patch as usual (ticrons on four corners with enough length to move within the field, save in moist saline gauze sandwich). Dissect as usual – aorta, PAs to hilum, duct, PA, SVC, IVC. Can desaturate when mobilising the PDA/PAs. Double-sloops around the PAs to carry out the…
Pre-op 1u blood available in PICU. Pacing box connected. Paddles available. Roll under shoulder. Side-bars down. Remove dressings before scrubbing. Head-light and loupes. Goretex unopened Procedure Clean with betadine. Fold the drape in half on either side, to prevent it from slipping off. Drape above and below, enough to get suction, etc. Stitch the drapes…
Decide from the CT scan which segments are more than 5.5cm, and if there is any coronary artery migration beyond the STJ. Cannulate in the arch – better to cannulate in the anterior part of the arch near the brachiocephalic artery, behind the innominate vein. No need to sling the vein usually. CP/Vent cannula to…
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Revascularisation CABG vs OMT ECSS – European Coronary Surgery Study CASS – Coronary Artery Surgery Study CABG vs POBA BARI Bypass Angioplasty Revascularization Investigation 1997 RCT n=1829 RITA 1 Randomised Intervention Treatment of Angina ERACI Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 1996 RCT n=1011 MASS Medicine,…
Drugs Aprotinin (trasylol) – polypeptide – competitive serine protease inhibitor – inhibits plasmin (low conc), and kallikrein (which inhibits XIIa)(high conc). Aminocaproic acid (amicar) – amino acid lysine analogue – Tranexamic acid () – amino acid lysine analogue – binds to lysine receptor sites on plasmin which prevents it from binding to fibrin. Research Mangano…