Off Pump and On Pump Coronary Anastomosis Technical Considerations

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Off Pump and On PumpCoronary AnastomosisTechnica
l Considerations
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technically coronary anastomoses are the same
whether its on or off pump the same Dos and
Donts apply
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• deep pericardial sutures
• lift and rotate anterior wall into the operative
  field
• aids verticalisation (for access to the
  posterior and inferior circulation)

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stabilisation
suction
Octopus 2 plus LP
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secondary stabilisation
Starfish 2 heart positioner
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Starfish 2
Octopus 4 stabiliser
heart positioners
Urchin
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• CO2 mist blower
• clears bloody field

• intracoronary shunts
• bloodless field

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• intracoronary shunts
• bloodless field
• continued distal perfusion (myocardial
  protection)
• crucial for RCA

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• 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)

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• maintain temperature 36C
• adequate room temperature
• lower body Bair Hugger

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• cell saver
• useful but not always required