coronary artery bypass surgery

In recent years, with improved surgical conditions and improved surgical techniques, as well as improvements in anesthesia and extracorporeal circulation techniques, coronary artery bypass surgery has become a common cardiac surgery and a routine cardiac surgery that patients are willing to accept. In the various types of cardiac surgery performed each year in China, the number of cases of coronary artery bypass grafting has risen to the first place, and more patients have undergone percutaneous transluminal coronary angioplasty (PTCA) and Stent implantation. Treatment of diseases: angina pectoris acute myocardial infarction Indication 1. Refractory angina. 2. Left coronary artery stenosis and coronary artery multivessel disease. 3. Acute myocardial infarction with cardiogenic shock. Contraindications Diffuse coronary artery lesions, and mainly distal coronary artery injury, old myocardial infarction, isotope and echocardiography without viable myocardium, surgery is not helpful to improve cardiac function. Patients with significant cardiac enlargement, cardiothoracic ratio >0.75, ejection fraction <20%, left ventricular end diastolic diameter >70 mm, severe pulmonary hypertension, right heart failure, or severe liver and renal insufficiency should be surgically contraindicated. Preoperative preparation 1. Prepare according to the routine of cardiopulmonary bypass surgery. Try to improve heart function and increase cardiac reserve before surgery. 2. Oxygen inhalation, with hypoxic hair, the authors take propranolol (property) and other drugs. Surgical procedure (a) aortic bypass grafting 1. Cut the graft vein: external rotation of the lower extremity, under the knee. Along the great saphenous vein, from the fossa ovalis to below the knee joint, multiple longitudinal incisions were made. The saphenous vein was dissected carefully and gently, and its branches were ligated and cut at a distance of 0.2 cm from the trunk. The branch between the incisions can be clamped at the distal end of the incision and then cut off, and then the proximal end is ligated after being taken out. 2. Preparation of graft vein: Placed at the distal end of the removed saphenous vein, and fixed the non-invasive needle, injecting physiological saline, flushing the blood in the tube and causing the lumen to expand moderately. The proximal and distal saphenous veins were cut at 45° to the long axis. If the blood vessels are found to be leaking, they are sutured horizontally with atraumatic thin lines. 3. The median incision of the sternum reveals the heart and establishes extracorporeal circulation. 4. Reveal the left ventricle of the left ventricle and its surface. 5. Coronary incision: the longitudinal anastomosis of the coronary artery is performed in a longitudinal section, and the sharp scissors are used to extend to about twice the length of the vessel circumference. 6. Vascular anastomosis: the proximal saphenous vein of the saphenous vein and the coronary artery incision were sutured with 7-0 non-invasive suture interrupted valgus end, a total of 10-12 needles, no ligation. 7. After suturing, close the anastomosis, tighten the suture, and ligature one by one. After the heart is re-bounced and the circulation is stabilized, the distal end of the great saphenous vein is anastomosed to the aortic end-to-side, and the aortic bypass graft is completed. 8. If there are multiple parts of the coronary artery, three bypass grafts can be performed. 9. The heart re-jumps, the extracorporeal circulation is stopped, and after the drainage tube is placed, the incision is closed layer by layer. (B) thoracic internal artery bypass grafting 1. Free internal thoracic artery: median sternal incision. The internal thoracic artery was freed from the sternum, and the intercostal artery was cut with an electric knife at a distance of 0.2 cm from the internal thoracic artery. 2. Establish extracorporeal circulation. 3. Cut the internal thoracic artery at the sixth intercostal level. The distal end of the obstruction of the anterior descending coronary artery and the internal anastomosis of the internal thoracic artery were longitudinally incision. The excessive part of the internal thoracic artery will be cut off during the anastomosis. 4. Vascular anastomosis: the proximal saphenous vein of the saphenous vein and the coronary incision were sutured with 7-0 invasive suture interrupted valgus end 10~12 needles, and were not ligated. 5. The heart is re-jumped, the extracorporeal circulation is stopped, and after the drainage tube is placed, the incision is closed layer by layer. complication Postoperative infection.