DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Coronary artery disease.
POSTOPERATIVE DIAGNOSIS:
Coronary artery disease.
OPERATION PERFORMED:
1. CABG x4, left internal mammary artery to the left anterior descending, vein to the circumflex, obtuse marginal, and right coronary artery.
2. Transonic flow analysis.
SURGEON: John Doe, MD
COMPLICATIONS: None.
CONDITION: Stable.
DESCRIPTION OF PROCEDURE: The patient was prepped and draped in the appropriate manner, having undergone general endotracheal anesthetic in addition to Swan-Ganz catheter placement. A midline sternotomy incision was utilized in standard fashion. The sternum was opened. The left internal mammary artery was taken down with clips and Bovie cauterization. Papaverine was placed, and the mammary artery vein was harvested. From the leg, 4-0 ties and clips were placed in the vein branches. A total heparinizing dose was given. We placed the patient on cardiopulmonary bypass support and cooled to 28 degrees. External cross-clamp was applied. Antegrade and retrograde cold blood cardioplegia was delivered. The heart was arrested.
Bypasses were performed to the obtuse marginal, the main circumflex, and the distal right with 7-0 Prolene distally and 6-0 Prolene proximally on the side of the aorta. The left internal mammary artery was anastomosed to the LAD with size 18 coalescent clips. Two 6-0 was utilized to fix this pedicle on the anterior surface of the heart. The patient was given a warm hot shot of warm retro followed by warm antegrade blood cardioplegia and returned to normal sinus rhythm. The cross-clamp was removed. Cooley needle was hooked to suction. The patient was rewarmed to 38 degrees and weaned from cardiopulmonary bypass support without difficulty.
Cannulas were removed and reinforced. The mediastinum was irrigated with warm bacitracin solution. Hemostasis was achieved in the standard fashion. The sternum was closed with #6 wire, heavy Dexon suture, running #1, 2-0 and 4-0 were subsequently utilized. Dressings and Steri-Strips were applied, and the patient was transferred to the cardiovascular intensive care unit in stable condition.
Transonic flow analysis was utilized to evaluate flow in the mammary and all three vein grafts, and they were found to be greater than 100 mL per minute of blood flow. Transesophageal echocardiogram showed excellent LV function following myocardial revascularization.
CABG Surgery Sample Report #2
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Coronary disease.
POSTOPERATIVE DIAGNOSIS: Coronary disease with severe osteoporosis of the sternum.
OPERATION PERFORMED: CABG x2 to left anterior descending and right and modified pectoral flap closure of the sternotomy.
SURGEON: John Doe, MD
DESCRIPTION OF OPERATION: Under endotracheal general anesthesia, routine surgical prep and drape applied. The saphenous vein was harvested from both thighs using EVH and then opened and closed in usual fashion. A median sternotomy was done. Sternum was found to be extremely thin and severely osteoporotic, and because of that, we did modified pectoral flap closure of the sternotomy. Heparin was given. Cannulation was done in the usual manner.
Cardiopulmonary bypass started. Temperature drifted down to about 33 degree centigrade. A sump drain was placed in the left ventricle through the right superior pulmonary vein. Aorta was cross-clamped. Cardioplegia was given until cardiac standstill obtained. The saphenous vein was anastomosed to right coronary artery. A 2 mm probe easily got through the anastomosis down to the bifurcation. Anastomosis was done with continuous suture of 7-0 Prolene and another vein anastomosed to mid portion of LAD using same technique. The aortic clamp removed. The patient warmed. Spontaneous heartbeat obtained. Using partial occluding clamp, proximal anastomosis of the grafts was done with continuous sutures of 5-0 Prolene.
Cardiopulmonary bypass discontinued. Decannulation done in the usual manner. Adequate hemostasis was established. Pericardium was irrigated with warm saline. Two chest tubes were placed down to the mediastinum. Temporary pacemaker electrodes were placed. Pectoral flap was developed in the mid portion of the sternum. This was not as extensive as classic pectoral flap.
The sternum was reapproximated with stainless wires. Pectoral flap was sutured with interrupted sutures of #1 PDS, the rest of the fascia was closed with interrupted sutures of #1 PDS, and the rest of the incision closed in layers. The patient was transferred to heart unit in stable condition.
