off-pump coronary artery bypass grafting

In 1962, Sabiston first completed the aortic-right coronary artery transplantation with a great saphenous vein under heart beat. In 1964, DeBakey and Kolessov used the saphenous vein and the internal mammary artery to perform the left anterior descending coronary artery under non-extracorporeal circulation. Bypass transplant. However, with the widespread use of extracorporeal circulation techniques and increased levels of myocardial protection, coronary artery bypass grafting under cardiopulmonary bypass has become a routine technique. However, there are still some countries such as Brazil, Agenyan and other cardiac surgeons who have been insisting on CABG in the non-cardiopulmonary bypass. With the development of minimally invasive surgery and the continuous improvement of coronary artery surgical instruments, the off-pump CABG through the mediastinum has been greatly developed. Some have included off-pump CABG in minimally invasive coronary artery bypass graft surgery. Treating diseases: arrhythmia Indication Off-pump coronary artery bypass surgery is applicable to: The choice of surgical cases still depends to a large extent on the extent to which surgeons and anesthesiologists have mastered the technology, as well as the special retractors, fixes and other conditions. According to reports, the off-pump CABG procedure currently accounts for about 15% to 80% of the total CABG. However, CABG still dominates CABG under classical cardiopulmonary bypass. Prior to the advent of special retractors and fixators, off-pump CABG was mainly used for patients with left anterior descending and/or right coronary lesions. With the improvement of the fixator and the accumulation of experience, the authors suggested that off-pump CABG can be applied. All target vessels in 3 vessel lesions. In the following 4 cases, it is not appropriate to use this surgical method: 1 diffuse coronary artery disease with small blood vessel diameter, calcification or need for endometrial ablation: 2 target blood vessels walking in the myocardium are not easy to dissect; 3 moving the heart to be revealed When anastomosed blood vessels cause irreversible blood pressure drop and severe arrhythmia: 4 patients with valvular disease or intracardiac malformation need to open the heart. Surgical procedure General anesthesia, conventional tracheal intubation, open the sternum incision through the middle, spare artificial heart-lung machine but not pre-filled. The inner mammary artery was freed, and low-dose heparin (1 mg, kg) was used to maintain the activation of whole blood clotting time (ACT) for 300 s. The vascular bridge preparation was performed according to a conventional method. By controlling the depth of anesthesia or adjusting the heart rate to -blockers around 60, min. Use a special sternum retractor to open the sternum. Longitudinally cut the happy bag, do 2 or 3 pericardial traction lines parallel to the left phrenic nerve, suture another pericardial traction line near the apex, hold the heart up: you can also use the suction cup tractor to attract the apex, before revealing separately Declining, gyroscopic and posterior descending coronary arteries. The application of suction cup traction has little effect on hemodynamics, and has outstanding advantages in revealing the right crown, the blunt edge branch and the posterior descending branch. The CTS stabilizer is used to locally fix the coronary artery that is ready for anastomosis, reducing the amplitude of the heart beat and facilitating the operation. Under normal circumstances, the left internal mammary artery-anterior descending artery anastomosis is performed first, and other target vascular anastomosis is performed. Incision of the coronary artery, the anastomosis of the blood can be sent to the coronary artery through the incision into the subthreshold empty cardiovascular arrester (shunt); or with a 5-0 polypropylene line around the preoperative anastomosis of the coronary artery near and distal and The lumen was temporarily blocked to provide a bloodless anastomosis field of view, and the distal anastomosis of the vascular bridge was performed first by conventional anastomosis. Then the upper side wall of the ascending aorta was clamped and perforated for proximal anastomosis of the vascular bridge. The patient's ECG, blood pressure, heart rate, and oxygen saturation were continuously monitored during the procedure. Swan-Ganzs catheters were placed to continuously monitor pulmonary arterial pressure and pulmonary arteriosus compression. Postoperative diet 1. Eat foods rich in high quality protein; 2. Eat foods rich in carbohydrates; 3. It is advisable to eat foods rich in vitamins and dietary fiber; 4. Avoid spicy foods.

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