CLINICAL CASE

MYOCARDIAL REVASCULARIZATION
WITHOUT CEC

Daniela Quintero Monsalve

01200021025
• This surgical procedure to improve the irrigation of the heart,
also known as coronary artery bypass, consists of the removal
of a saphenous vein bridge, mammary artery, radial artery to
be placed in the artery that lacks irrigation.
ANATOMY
The coronary arteries are blood vessels that supply oxygen-rich
blood and other nutrients to the heart muscle. The coronary
arteries are attached to the surface of the heart and wrap
around it.
PATIENT DATA
Name: Juan Eduardo Medina Perez
Age: 71 years old
Weight: 53 kg
Height: 1,53
Body surface: 1.53
Flow: 3.82
Heparin: 3.7 mL
EF: 65%.
BACKGROUND

Patient with coronary artery disease since 2010

Medications consumed: Valsartan and atorvastatin

DIAGNOSIS
Recurrent syncope on study + ischemic heart disease severe
coronary artery disease AD
EXAMINATIONS PERFORMED

-CORONARY ARTERY ANGIOGRAPHY WITH CATHETERIZATION

Performed due to chest pain with positive stress test for

myocardial ischemia.

-Left coronary artery: Main trunk without lesions.

- LAD: 100% occluded in its proximal segment.
-Circumflex: Good size with no lesions.
-Right coronary artery: Permeable, good caliber without
obstructive lesions.
PATIENT POSITIONING

ANESTESIA: General
INCISIÓN: Esternotomy
CHECK LIST
OPERATING TABLES

Radiopaque gauze
Protected mosquito forceps
Farabeuf retractors
Thick and thin vascular dissections
Metzembaum scissors
May scissors
Scalpel handles
Kelly Forceps
Kelly adson forceps
Rochester Forceps
Tube Clamp
Sharp Cups
OPERATING TABLES
Equipment and clothing package
Wire holder and cutter
Aortic clamps
Dissections with and without clamp
Hooks
Micro dissections
Anterograde and retrograde micro
scissors
Clips and ligaclip forceps 100 and 200
Frazier cannula for co2
Sternal and mammary retractors
Sutures
Long may scissors
Needle holder
Starfish
Silastic bands
SURGICAL TEAM LOCATION
PROCEDURE
- Perform incision with scalpel 15 and hemostasis with electroscalpel.
- Separate with Farabeuf to clear the sternal notch, xiphoid process and make the incision in the muscle with an electroscalpel.
- With a reciprocating saw, the sternotomy is performed and separated with Farabeuf to hemostasis the bone with an
electroscalpel and bone wax.
- The breast separator is placed to extract the graft and a tube is placed to protect the separator.
- With dissection and electroscalpel, the artery is searched and cut and dissected. This is done with 100 and 200 clips
. - The doctor advises to place heparin
- After having the mammary artery, it is placed in a moist gauze and must be clamped with a bulldog clamp.
- The mammary separator is removed and the sternal separator is placed with the same protectors.
- After the patient is heparinized, the surgeon will place gauze and a compress under the heart to lift it and improve exposure.
- Locate where the anastomosis will be performed and place the octopus stabilizer
- With a micro scalpel, a small incision is made in the epicardial stage to perform the anastomosis.
- With a silastic band, the conditioning of the coronary artery is performed, that is, arteriotomy.
- With CO2 it is supported to clear the blood and have better visualization to perform the anastomosis
- The patency of the anastomosis is verified and the clamp is removed from the artery.
- The stabilizer and compresses are removed - Warm saline solution is applied and pacemaker thread
PROCEDURE
- The incisions are made for the placement of the chest tube.
- The chest tubes are arranged in an X shape and fixed with the previously made loops.
- The sternum is closed with a surgical steel wire holder and cutter mounted on its tip with a Rochester forceps. –
- Muscle and tcs are closed with vicryl 0
- Apply infiltration with bupivacaine
- Skin is closed with 3/0 monocryl
- A Y connector is placed for the tubes and the pleurovac
- The dermabond is applied to seal the wound and allowed to dry before complete healing.
- Wounds are cleaned and healed with Tegaderm
PROCEDURE
PROCEDURE
PROCEDURE
PROCEDURE