By Siavosh Khonsari
Now in its Fourth variation, this article is a realistic, seriously illustrated advisor to systems in cardiac surgical procedure. Chapters hide obtained and congenital illnesses and comprise surgical anatomy, surgical exposures, and step by step procedural info. The authors point out pitfalls with a possibility signal and flag issues of exact curiosity with "NB" (Nota Bene).
This variation has contributions from Abbas Ardehali, MD, FACS, the director of the UCLA middle, heart-lung, and lung transplant application. Highlights contain a brand new bankruptcy on center transplantation. additionally integrated are updates in minimally invasive surgical procedure and vascular and endovascular surgery.
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Additional resources for Cardiac Surgery: Safeguards and Pitfalls in Operative Technique
Technique A 6- to 8-cm midline skin incision is made starting approximately 2 to 3 cm below the suprasternal notch. Short flaps of subcutaneous tissue are developed both superiorly and inferiorly to expose the sternum. With a pneumatic or a small oscillating saw the sternum is divided from the suprasternal notch down to the third or fourth interspace. An angled bone cutter is used to divide the sternum into the right, left, or both intercostal spaces. A Finochietto sternal retractor provides good exposure.
Although the axillary artery can be directly cannulated in many individuals, the risk of dissection has led many surgeons to suture a 7- or 10-mm Dacron tube graft (end to side) to the axillary artery with a 4-0 or 5-0 Prolene suture, followed by cannulation of the tube graft (Fig. 2-14). At the completion of cardiopulmonary bypass, the base of the tube graft is ligated with two large metal clips flush with the axillary artery wall. The graft is trimmed to 1 cm and the end is oversewn with 5-0 Prolene.
It is then connected to the arterial line, making sure that all air has been removed from the circuit. FIG 2-5. Controlling bleeding after injury to the aorta. In patients undergoing reoperation with scarred aortic walls or pediatric patients, it may be useful to insert an appropriately sized Hegar dilator through the stab wound before inserting the aortic cannula. 24 SECTION I • General Considerations Porcelain, Lead Pipe, or Eggshell Aorta Porcelain, lead pipe, or eggshell aorta is the term used when the entire ascending aorta is calcified.