Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified)
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Coronary Artery Bypass Surgery Microchapters | |
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Coronary artery bypass surgery the traditional coronary artery bypass grafting procedure (simplified) On the Web | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Mohammed A. Sbeih, M.D. [3]
The Traditional coronary artery bypass grafting procedure (simplified)
- The patient is brought to the operating room and moved onto the operating table.
- An anesthetist places a variety of intravenous lines, often including a pulmonary artery catheter and injects an induction agent (usually propofol) to render the patient unconscious and to anesthetize the patient.
- An endotracheal tube is inserted and secured by the anesthetist or a respiratory therapist and mechanical ventilation is started.
- The chest is opened via a median sternotomy and the heart is examined by the surgeon.
- The grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins.
- The surgeon stops the heart and initiates cardiopulmonary bypass; or in the case of "off-pump" surgery, places devices to stabilize the heart.
- One end of each graft is sewn onto the coronary arteries beyond the blockages and the other end is attached to the aorta.
- The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the aorta is partially occluded by a C shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating. This reduces time spent on the heart lung machine.
- The sternum is wired together and the incisions are sutured closed.
- The patient is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the patient is transferred to the cardiac surgery unit until ready to go home (approximately 4 days).
2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (Please do not edit) Use of Epiaortic Ultrasound in Patients Undergoing CABG.
| Class IIa |
| " 1. In patients undergoing CABG, the routine use of epiaortic ultrasound scanning can be useful to evaluate the presence, location, and severity of plaque in the ascending aorta to reduce the incidence of atheroembolic complications (Level of Evidence B-NR)". |
2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (Please do not edit) Use of Cardiopulmonary Bypass in Patients Undergoing CABG
| Class IIa |
| " 1. n patients with significant calcification of the aorta, the use of techniques to avoid aortic manipulation (off-pump techniques or beating heart) is reasonable to decrease the incidence of perioperative stroke when performed by experienced surgeons.(Level of Evidence B-R)". |
| '' 2. In patients with significant pulmonary disease, off-pump surgery may be reasonable to reduce perioperative risk when performed by experienced surgeon (Level of Evidence B-R)'' |
References:
- ↑ 1.0 1.1 "Correction to: 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (11): e771. 2022. doi:10.1161/CIR.0000000000001061. PMID 35286170 Check
|pmid=value (help).