An introduction of Coronary Artery Bypass Grafting.pptx

Coronary Artery Bypass Grafting- An introduction

1. CABG Nabin Paudyal

2. Indications Vessel unsuitable for PCI Multiple diseased bypass graft Availability of internal mammary artery Good distal targets for bypass graft CABG is postponed to at least 3 days after AMI

3. Pre-operative preparation H/O Physical examination including conduit evaluation Review of medications Pre-operative basal metabolic panel Carotid Duplex USG ECHO  Complete structure study Cardiac viability study To decide between PCI vs CABG

4. Steps of CABG Phase 1 Establishment of anesthesia and intraoperative monitoring Positioning and draping MEDIAN STERNOTOMY IMA harvesting and conduit evaluation Phase 2 Heparinization and cannulation for bypass Establishment of bypass Instillation of cardioplegia and myocardial arrest Identification of diseased vessel and construction of distal anastomosis Restoration of myocardial electromechanical activity

5. Steps of CABG Phase 3 Creation of proximal anastomosis Weaning from bypass Evaluation for and establishing necessary adjuncts  Inotropes, pacing wires Phase 4 Reversal of anticoagulation and establishment of hemostasis Evaluation of surgical sites and establishment of surgical drainage Closure of sternotomy.

6. Heart Lung Machine Components Cannula Blood reservoir Cardioplegia Oxygenators Heat exchanger Roller pumps/ Centrifugal pump Heparin pump

7. Cardiopulmonary bypass CPB is the establishment of extracorporeal oxygenation and perfusion of the human body by diverting all returning venous blood from the body to heart-lung machine and returning the oxygenated blood in a controlled, pressurized manner. Critical step for many cardiac procedure

8. Anti-coagulation protocol in CPB Pump prime is premixed with 4 U/mL heparin Patient is heparinized with 300U/kg before cannulation Activated clotting time obtained approximately 3 minutes after heparin administration should be more than 400 seconds before cannulation is begun

9. Cardioplegia solution

10. Complications after CABG Tamponade Postoperative bleeding Neurologic complications Mediastinitis Renal dysfunction