J.Jpn. Surg. Soc.. 79(8): 831-836, 1978
Report on the annual meeting
AORTOCORONARY BYPASS: SURGICAL TECHNIQUE AND RESULTS
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First Department of Surgery, Osaka University Hospital Yasunaru Kawashima, M.D., Soichiro Kitamura, M.D., Tohru Mori, M.D. |
Surgical Techniques: The patient is placed in the supine position with both legs rotated outer and bent at the knee joint (frog position). The saphenous vein graft is harvested with its all branches hemoclipped. Before going on cardiopulmonary bypass, the graft is sutured to the ascending aorta in almost all patients. The aorta is simply incised with a partial clamp on, and the reversed saphenous vein graft is anastomosed with 5-0 or 6-0 continuous prolene sutures. The distal anastomosis is carried out always on cardiopulmonary bypass. Cold potassium cardioplegic solution is injected into the ascending aorta. Also the heart is immersed in the ice slush of LactateRinger's solution placed in the pericardial sac. The distal anastomosis is performed with 6-0 or 7-0 prolene continuous stitches. When the heart becomes distended, a vent tube is inserted into the pulmonary artery trunk. This venting technique is easy and effective.
Results: The over-all surgical mortality has improved from 19.0 to 6.8% since 1976. In the group of patients with an ejection fraction of less than 0.5, the mortality was 23.8% in contrast to 4.5% in patients with an ejection fraction of more than 0.5. In 90% of the surviving patients, singificant clinical improvements have been achieved.
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