www.surgicalnotes.co.uk

Before surgery

• Blood, blood products
• Tranexamic acid
• Aprotinin

Monitoring

• Bilateral radial lines
• Femoral line (left side, leave right for cannulation site)

Preparation

• Shave both groins, legs
• Sites for access (1) sternum (2) axilla (3) legs - for saphenous vein harvest

Incision

• Type A: Median sternotomy
• Type B: Left lateral thoracotomy

Procedure

Set up:

1. Open the chest and pericardium
2. Give heparin
3. place purse-string sutures
4. Cannulate - options include:
   • 2-stage cannula in right atrium + arterial return to distal aorta / aortic arch
   • Aorto-caval cannulation
   • Fem-fem cannulation
   • Axillary cannulation
5. Go on bypass
6. Cool to 28-32'C
7. Separate the aorta from the PA
8. Cross-clamp the distal ascending aorta
9. Open the ascending aorta, either;
   • Beating heart
   • Fibrillating heart
   • Retrograde CP
10. Give cardioplegia directly into the coronary ostia

Interpositional graft:

1. Open the aorta transversely + use pump sucker to vent the heart

Venting

• Right superior PV
• LV apex