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During Your Surgery

Open Heart Surgery Handbook

Once you are on the operating table, monitoring lines will be established. This will be done by the anesthesiologist and by the surgical assistants. They will try to make this period as comfortable as possible for you. You will be give small amounts of a local anesthetic to start arterial and venous lines. You will also be connected to electrocardiogram monitoring lines. During this time, the anesthesiologist will be communicating with you and will let you know the moment when the general anesthetic is going to be given to you.

Once you are under anesthesia, the remaining preparations before surgery itself are carried out. The anesthesiologist will position endotracheal (breathing) and nasogastric (stomach) tubes, and central venous lines will be inserted.

In certain cases further monitoring of the heart will be performed by a device called Transesophageal Echocardiogram (TEE). This device is placed in your esophagus and positioned directly behind your heart. This information will facilitate continuous intraoperative cardiac monitoring and assure safe and expeditious care.

 Diagram of the heart-lung machine.

In the majority of cases, access to your heart is gained via a median sternotomy incision. This is an incision made longitudinally (from the top of the chest downward) in your breast bone. On occasion, it becomes necessary for you to have a different access point, such as through the left or right side of the chest. In a selective group of patients, a MIDCAB procedure (minimally invasive direct coronary artery bypass surgery) can be performed, and this is accomplished through a smaller incision in the right or left side of the chest wall. The grafting of the coronary arteries is done on a beating heart, without cardiopulmonary bypass. The internal mammary arteries are removed from inside the chest wall and the radial arteries may be removed from one or both forearms. One or more of these arteries will be used in virtually every case, since they have been documented to be grafts of superior quality in the long term. You may also have leg incisions from which the vein grafts will be harvested.

During the surgical intervention, you will be on cardiopulmonary bypass. This means that you will be connected to a heart-lung machine that will perform the work of your own heart and lungs, which will be at rest during the surgery. Your specific cardiac intervention will then be performed, as described elsewhere in this handbook.

Once the surgical procedure on your heart is complete, the surgeon will allow your heart to progressively take over the circulation and will allow your lungs to once again be ventilated for the oxygen exchange. Once your heart is performing well, the heart-lung machine will be progressively discontinued. At this point, the surgeon will insert a few tubes in your chest for drainage of residual blood after surgery. Sometimes he will leave temporary pacemaker wires, in case a pacemaker becomes necessary after surgery.

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