Transcript Beating Heart Total Arterial Revascularisation

Off Pump and On Pump
Coronary Anastomosis
Technical Considerations
technically coronary anastomoses are the same
whether it’s on or off pump
the same Do’s and Dont’s apply
deep pericardial sutures
 lift and rotate anterior wall into the operative field
 aids ‘verticalisation’ (for access to the posterior and inferior circulation)
stabilisation
suction
Octopus 2 plus LP
“secondary” stabilisation
Starfish 2
heart positioner
Octopus 4
stabiliser
Starfish 2
heart positioners
Urchin
CO2 mist blower
 clears “bloody” field
intracoronary shunts
 ‘bloodless’ field
intracoronary shunts
 ‘bloodless’ field
 continued distal perfusion (“myocardial protection”)
 crucial for RCA
patient position
 trendelenburg with rotation to the right
• to reduce haemodynamc impairment (due to right sided compromise)
• to improve access and visualisation (to the posterior /inferior circulation)
maintain temperature ~36°C


adequate room temperature
lower body “Bair Hugger”
cell saver

useful but not always required