Sternotomy. Leave pericardium closed until LIMA take-down. Saphenous vein harvest. Heparin after vein exposed/adequate length available. Cannulation. U-stitch for placing root vent/replacing with proximal anastomosis site. Bypass. X-clamp. Run the plegia. Prepare the vein graft/apply ligaclips. Estimate segments for targets. Fashion vein tip for anastomosis. Keep vein away. Ensure vein is not connected to the…

Left-sided grafts – held by assistant at superior aspect of sternotomy with ring-tip forceps held in the right hand. Aim for the heel at 1 ‘o clock on the aorta. Start backhand out-side in on the vein graft at its 3’o clock position. Right-sided grafts – held by assistant at inferior aspect of sternotomy with ring-tip…

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…