Coronary Artery Bypass Graft

Question 1

What is a Coronary Artery Bypass Graft?

Answer 1

Surgical procedure to fix Coronary Artery stenosis from plaque build-up

Question 2

Which vessels may be used as an autologous graft in a CABG?

Answer 2

• Left Internal Thoracic Artery
• Radial Artery (non-dominant hand)
• Saphenous Vein

Question 3

What is Patient Positioning for a CABG?

Answer 3

Supine with Bilateral Arms tucked

-Unless Radial Artery is harvested

Question 4

How much of the patient’s skin is prepped for a CABG?

Answer 4

From Chin to Umbilicus

• Down to foot if harvesting vein (both legs)
• Towels used to cover groin

Question 5

What type of incision is used during a CABG?

Answer 5

Midline Sternotomy

Question 6

What are the key instruments used in a CABG?

Answer 6

• Sternal saw

- Finochietto Rib Spreader

Question 7

Why is an Cardiopulmonary Bypass necessary during a CABG?

Answer 7

To allow blood to continue to circulate while the heart is stopped for anastomosis

Question 8

What are the steps for a Cardiopulmonary Bypass?

Answer 8

1. Cannulate ascending aorta
2. Cannulate right atrium
   2a. Connect Cannulas to Heart-Lung Machine
3. Cold Cardioplegia solution is given and Aorta is clamped distal to Cannula
4. Bypass begins

Question 9

What suture and technique is used when Cannulating the Ascending Aorta during a Bypass?

Answer 9

Two Silk Purse-String sutures placed around Aorta at site of incision and tightened to hold tubing in place

Question 10

What temperature do we want the patient’s body to be during a Bypass?

Answer 10

28-32 degrees Celsius

-Cell death slows at this temperature

Question 11

What is an Off Pump CABG?

Answer 11

A chemically induced slow heart rate that does not stop the patient’s heart during surgery

Question 12

When is an Off Pump CABG performed?

Answer 12

With high risk patients

• Kidney disease
• Calcified Aorta

Question 13

How is anastomosis achieved during Off Pump CABGs?

Answer 13

With the help of heart/tissue stabilizers

Question 14

What is the order of anastomosis for the Coronary Arteries during a CABG?

Answer 14

• Right Coronary Artery
• Marginal Artery
• Circumflex Artery
• Posterior Descending Artery
• Left Anterior Descending Artery

Question 15

What occurs immediately after the final anastomosis during a CABG?

Answer 15

• Warm patient back up
• Temporary pacemaker wires for post-op monitoring
• Two 32F chest tubes inserted in pleural space
• Patient stays intubated for 24hrs. to monitor BP

Question 16

What are the main roles of an SA during a CABG?

Answer 16

• Place A-line, Foley, and Rectal Temperature Probe
• Assist with Sternotomy (or Vein Harvesting)
• First assist until Distal Anastomosis begins
• Heart holds during Distal Anastomosis
• Assist closing Sternotomy