MYOCARDIAL

REVASCULARIZATION

Margy P. Paredes
Caballero

01180021022

Practice III
 DATA
Date Thursday 17 March 2021 Patient Laureano Mantilla Pérez
Institution FOSUNAB CC 91204476
Surgeon Carlos Ocampo Date of Birth 19-02-1958
Surgical inst Glenda Pabón Weight 62 kg
Size 172 cm
RH O+
VIH -
Hep B -
COVID 19 -
 ANATOMY
The coronary arteries are the arteries in charge of nourishing the entire heart. Its name comes from the Latin
word coronarĭus, which means crown-shaped, because of the way they surround the heart.
There are two coronary arteries, the right coronary artery and the left coronary artery, which arise at the
aortic root, from the right and left aortic sinuses respectively.
The left coronary artery has a short common path (left voronary trunk), rapidly bifurcating into the anterior
descending artery and the circumflex artery.
That is why the coronary system is usually considered as a system of three great arteries, the anterior
descending, the circumflex and the right coronary.
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 PATOLOGY
CORONARY HEART DISEASE.
It is the most common type of heart disease. CAD occurs
when the arteries that supply blood to the heart muscle
harden and narrow. This is due to the buildup of cholesterol
and other materials called plaque on the inner layer of the
artery walls. This buildup is called arteriosclerosis. As this
progresses, less blood flows through the arteries. As a result,
the heart muscle cannot receive the blood or oxygen it
needs.

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 SURGICAL OBJECTIVE

It consists of bypassing the blood flow

through native coronary arteries with
high-grade stenosis or occlusion with
the help of a vascular graft obtained
from the patient himself.

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 SURGICAL TECHNIQUE
General anesthetic induction.
Dressed and table setting.
Washing of the surgical area.
Dressed by the patient.
Dressed as the surgeon.
Initial count of compresses.
Location of surgical equipment and surgical tables.
Incision (scalpel # 3 blade # 15 - electrosurgical unit - Farabeuf retractors).
Sternotomy; incision of the sternum approximately 15 cm (scalpel # 7
blade # 15 - electrosurgical unit - Farabeuf retractors - compresses -
reciprocating saw - bone wax).

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 SURGICAL TECHNIQUE
Separation (breast separator)
Dissection of the internal mammary artery (electrosurgical blade
40 - ligaclip forceps - clips 100 and 200 - fine dissection forceps)
Change of separators (sternal separator)
Simultaneously, the second surgeon extracts the graft from the
saphenous vein (4/0 silk precut) (scalpel handle # 3 blade # 15 -
electrosurgical knife - Weitlaner retractor - mayo scissors -
bulldog clamps - coca - nitroglycerin solution - Metzembaum
scissors - clip garter clip - clips 200)
Incision and repair of the pericardium (Silk or round curved
needle - needle holder - vascular dissection forceps).

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 SURGICAL TECHNIQUE
Identification of structures.
Arterial and venous cannulation (Precut silk) (scalpel handle
# 7 blade # 15 - vascular dissection forceps - thread passer
- tourniquet - curved Kelly clamp - mayo scissors - arterial
and venous cannula).
Connection with the cardiopulmonary bypass machine
(cardiopulmonary bypass tubes - tube scissor connectors -
tube clamp).I
ncision of the aorta and onset of cardioplegia
(polypropylene 4/0 round 17mm curved needle) (antegrade
cardioplegia cannula).

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 SURGICAL TECHNIQUE
Incision of the right coronary artery in order to perform the
distal latero-terminal anastomosis of the saphenous vein
(polypropylene 7/0 round curved double needle - ticron 2/0
round curved needle with felt) (scalpel handle # 3 blade # 15 -
micro-scalpel - vascular dissection forceps - vascular scissors -
Castroviejo needle holder - mayo scissors)
Incision of the proximal aorta to create the lateral-terminal
bridge with the saphenous vein (polypropylene 6/0 double
round curved needle) (scalpel handle # 3 blade # 11 - punch -
vascular dissection scissors - Castroviejo needle holder -
scissors of May)

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 SURGICAL TECHNIQUE
Anastomosis of the internal mammary artery with
the left anterior descending aorta (polypropylene 7/0
round curved needles) (octupus - Castroviejo needle
holder - micro scissors)
Leak check (20cc syringe - heparinized saline)
Placement of the pacemaker thread (pacemaker
thread) (needle holder - mayo scissors).
Pump outlet and removal of vascular cannulas.

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 SURGICAL TECHNIQUE
Tube placement to thorax (# 3 scalpel handle # 15 blade - Silk
0 precut) (needle holder - curved Rochester forceps)
Count of compresses and gauze.
Suture of the sternum (surgical steel 5) (wire needle holder -
curved Rochester forceps - wire cutter).
Suture of the fascia and subcutaneous cellular tissue
(Poliglactin 910 round curved needle 36mm) (needle holder -
mayo scissors - long dissection without claw).
Skin suture (poliglecaprone 3/0 curved sharp needle) (needle
holder - mayo scissors - short claw dissection).

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 SURGICAL TECHNIQUE

Connection to drainage system (chest drain -

nelaton tube # 14)
Removal of cables and rubbers.
Cleaning and healing; Incisional field removal
(liquid suture) (wet compresses - saline solution
- dry compresses - dressings - sterile gauze)
Surgical clothing removal.

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 REFERENCES
Anatomía de las Arterias Coronarias. https://www.my-ekg.com/bases/arterias-coronarias.html
Enfermedad de las arterias coronarias. https://medlineplus.gov/spanish/coronaryarterydisease.html
Cirugía de revascularización coronaria. https://medlineplus.gov/spanish/ency/article/002946.htm
Cirugía de Revascularización Coronaria (Bypass).
https://www.clinicbarcelona.org/asistencia/pruebas-y-procedimientos/cirugia-de-revascularizacion-coronaria
-bypass/definicion
Cirugía de revascularización miocárdica (CABG, coronary artery bypass grafting).
https://www.msdmanuals.com/es-co/professional/trastornos-cardiovasculares/pruebas-y-procedimientos-car
diovasculares/cirug%C3%ADa-de-revascularizaci%C3%B3n-mioc%C3%A1rdica-cabg-coronary-artery-bypa
ss-grafting