DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Severe coronary artery disease.
2. Angina pectoris.
3. Hypertension.
4. Hyperlipidemia.
5. Tobacco abuse.
6. Positive family history of coronary artery disease.
POSTOPERATIVE DIAGNOSES:
1. Severe coronary artery disease.
2. Angina pectoris.
3. Hypertension.
4. Hyperlipidemia.
5. Tobacco abuse.
6. Positive family history of coronary artery disease.
OPERATION PERFORMED: Coronary artery bypass graft x2 using the left internal mammary artery to the LAD and reverse saphenous vein graft to the circumflex artery.
SURGEON: John Doe, MD
ANESTHESIA: General.
PUMP TIME: 49 minutes.
CROSS-CLAMP TIME: 30 minutes.
LOWEST TEMPERATURE ON PUMP: 34 degrees Celsius.
DRAINS: Two chest tubes, 1 Blake drain, 1 bipolar pacing wire.
COMPLICATIONS: None.
OPERATIVE FINDINGS: The left internal mammary artery was a good conduit. Reverse saphenous vein graft was adequate but very thick walled. LAD was a good 1.75 mm to 2 mm target. Circumflex was a good 1.75 mm to 2 mm target.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in the supine position. Support lines were placed. General anesthesia was given via endotracheal intubation. The chest, abdomen and lower extremities were prepped and draped in the usual sterile fashion. The saphenous vein was harvested from the left lower extremity. Hemostasis was ensured and wounds were closed in layers. Simultaneously, a median sternotomy was performed.
The left sternum was elevated and the left internal mammary artery was harvested as a pedicle graft. Systemic heparinization was performed. Distal pedicle was divided and the left internal mammary artery was prepared for future grafting. Intrapedicle papaverine was administered. A Morse sternal retractor was placed. Pericardium was opened and a cradle was created. Cannulation for cardiopulmonary bypass was achieved. Catheter was placed in the ascending aorta for administration of blood cardioplegia as well as venting. Cardiopulmonary bypass was instituted once the ACT was satisfactory.
Distal target coronary arteries were identified and marked. Saphenous vein lengths were measured and the saphenous vein was prepared. Systemic cooling was begun. Aortic root cross-clamp was applied. Antegrade cold cardioplegia was administered. Topical cooling was utilized. Repeat cardioplegia and topical cooling were administered following each distal anastomosis. Cardioplegia was also given down each vein graft following each distal anastomosis. The circumflex artery was exposed and opened longitudinally and a reverse saphenous vein graft was anastomosed in an end-to-side fashion using continuous 7-0 Prolene suture.
Once this was performed, the LAD was exposed and opened longitudinally. The left internal mammary artery was anastomosed through the LAD in an end-to-side fashion using continuous 7-0 Prolene suture. Rewarming was begun. Warm blood cardioplegia was administered followed by warm blood perfusate down the vein. The left internal mammary artery flow was allowed to pass into the LAD system. Hemostasis was ensured. Deairing was ensured. The aortic cross-clamp was removed. A partial occluding clamp was placed on the ascending aorta. One punch aortotomy was performed. Saphenous vein graft was then placed in an end-to-side fashion using continuous 7-0 Prolene suture. Deairing was ensured and the partial occluding clamp was removed. Marker ring was placed at the end of the anastomosis. A bipolar pacing wire was placed in the right ventricle. Cardiopulmonary bypass was weaned and discontinued without any problems. Protamine was administered. Decannulation was carried out and all sites were secured.
Hemostasis was ensured. Two chest tubes were placed, one in the left chest cavity, one in the anterior mediastinum. A Blake drain was placed in the posterior pericardium. The sternum was then approximated with #6 stainless steel wires. Two small catheters were placed on top of the sternum. Proximally, those catheters were connected to a pain management pump device. The chest wall was then closed in layers. The patient tolerated the procedure and was transferred to a cardiovascular recovery unit in stable condition.
