Pontage coronarien
le trait d'union entre toutes vos procédures
CORONARY BYPASS
Peters Surgical is your partner, from opening to closing
Coronary Artery Bypass Grafting (CABG) is the most commonly performed cardiac surgery procedure in the world for patients suffering from heart attacks and severe blood vessel diseases.
By definition, Coronary Bypass Grafting is a surgical procedure that involves “bypassing” one or more blocked coronary arteries by grafting blood vessels.
In order to better understand the conduct of the most commonly used procedures and techniques, Peters Surgical and Dr. Amedeo Anselmi MD, Thoracic and Cardiovascular Surgeon at the University Hospital of Rennes (France) presents a series of short videos on this specific procedure.
In this miniseries, Coronary Bypass Surgery has been summarized in 5 surgical steps, focusing on the surgical technique as well as the choice of the products used.
Introduction by Dr. Amedeo Anselmi
Franco-Italian Thoracic and Cardiovascular surgeon, member of the board of the French College of Thoracic and Cardiovascular Surgery, editorial member of several cardiovascular journals, he practices the various techniques of modern cardiac surgery such as minimally invasive surgery.
In this first video, he explains in detail how Coronary Bypass surgery is performed and which technique he uses. This may vary between surgeons and countries.
Opening the heart
Median sternotomy, as a procedure of open-heart surgery, is the gold standard incision for most cardiac operations.
With the advent of new approaches emerged in cardiac surgery, Minimally Invasive direct Coronary Artery Bypass Grafting (MIDCAB) can be performed via Distal Mini-Sternotomy (DIMS).
The first step of the procedure involves the opening and exposure of the heart in open-heart surgery.
You will find the most suitable sutures for the suspension of the pericardium, such as our Polytresse® braided sutures, as well as the sizes of titanium clips (Clip 9 Vitalitec® or Clip SLS Vitalitec®) necessary for the hemostasis of the mediastinal veins or arteries.
Harvesting of arterial and/or venous grafts
Depending on the chosen Coronary Bypass Surgery technique, surgeons will harvest the internal thoracic artery (ITA/LIMA) and/or the saphenous vein.
Dr. Anselmi MD shows us his choice of products for each graft harvest, called skeletonization, in this video where he uses:
- A certain amount of surgical titanium ligation clips (Clip 9 Vitalitec® or Clip SLS Vitalitec®) for hemostasis and separation of collateral branches.
- Atraumatic bulldogs (Greyhound® or Novaclip®) are used for temporary occlusion, as well as for checking vessel permeability.
- An absorbable braided suture (Optime®) for closing subcutaneous layers after saphenous vein.
Cannulation and clamping of the aorta
During the procedures in which under Cardiopulmonary Bypass (CPB) is used, the heart will therefore be inert and will not pump blood. Temporary clamping of the aorta is necessary in this case, and the use of the Cygnet® or a Bahnson type cross clamp with protective inserts (Intrack® Ultra ) is common.
Sutures will be used to hold the various cannulas (bursa) in place with a non-absorbable braided suture (Cardioxyl®)
If the beating heart technique is preferred, as the procedure does not require Cardiopulmonary Bypass (CPB), partial clamping of the aorta may be performed using a Lambert-Kay clamp.
Distal and proximal anastomosis
The key step in Coronary Artery Bypass surgery is to make the anastomoses (connections between blood vessels).
Depending on the type of bypass, a distinction is made between distal anastomosis (anastomosis between the distal end of the graft and the coronary) and proximal anastomosis (anastomosis between the graft and the ascending aorta)
Non-absorbable sutures are chosen for anastomosis, such as Corolene® (polypropylene sutures) or Premio® (PVDF sutures).
Another surgical technique allows beating heart Coronary Bypass surgeons to perform proximal anastomoses without clamping the aorta using the Enclose® II device.
Sternal and skin closure
All cardiac procedures use numerous sutures to close the different planes during the conventional cardiac procedure.
This last video describes the different choice of sutures:
- Steel wire for closing the sternum
- A medium absorbable braid for the pericardium, muscle/fascia and subcutaneous layer (Optime®)
- An absorbable or non-absorbable monofilament (Filapeau®, Advantime® or Optime® R) for skin closure.
The choice of suture depends mainly on the surgeon’s preference and the technique used.
The important thing is obviously to achieve the best possible result for the patient.
