OR / Prep · Cardiac Surgery · open
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Coronary artery bypass grafting
Why are we operating?
New plumbing around blocked coronaries: conduit from the chest wall and leg, grafted onto the arteries beyond their disease, classically on a heart stopped and lent to a machine.
Indication: Left main or three-vessel coronary disease, and diabetics with multivessel disease, where surgery outlives stenting.
The operation in 4 steps
01Sternotomy and conduit harvest
02Cannulation, bypass, arrest
03The anastomoses
04Weaning and closure
Danger zones
Left main coronary artery
Two territories hang from one vessel; its disease changes the whole operative plan.
AV nodal artery
Injury or occlusion at the crux trades a rhythm for an infarct.
Coronary sinus
Thin-walled and posterior, easily torn by retraction during mitral exposure.
Watch it done
Cardiopulmonary bypass: the role of the circuit
Why the operation needs a machine at all: a still, bloodless heart with the body still perfused.
Source: CTSNet · Watch on YouTubeCardiopulmonary bypass: the circuit
The path blood takes from the venous cannula through the reservoir, oxygenator and pump back into the aorta.
Source: CTSNet · Watch on YouTubeCardiopulmonary bypass: circuit components
Each part of the circuit named and explained: cannulae, reservoir, pump heads, oxygenator, filters and suckers.
Source: CTSNet · Watch on YouTubeCardiopulmonary bypass: pathophysiology
What non-pulsatile flow, haemodilution, hypothermia and the foreign circuit do to the body, and why the ICU course follows.
Source: CTSNet · Watch on YouTubeCardiopulmonary bypass: conduct and weaning
Going on, running the pump, and the choreography of coming off: rewarming, rhythm, filling and the cannulae out.
Source: CTSNet · Watch on YouTubeCardiopulmonary bypass: emergency scenarios
What goes wrong on the pump and what the team does in the first minute: air, dissection at the cannula, pump failure, oxygenator failure.
Source: CTSNet · Watch on YouTubeCoronary artery bypass surgery
Sternotomy, conduit, bypass and the grafts, in the words of the centre that does the most of them.
Source: Cleveland Clinic · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.