CABG, valve repair and replacement, aortic surgery and congenital repairs from the perfusionist's view: cannulation strategies, and key operative steps.
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- What is the standard arterial cannulation site for routine (non-aortic) CABG?
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The ascending aorta- What venous cannulation strategy is typical for routine CABG?
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A single two-stage venous cannula placed in the right atrium- What is the purpose of an antegrade cardioplegia cannula?
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To deliver cardioplegia solution into the aortic root to arrest the heart- Where is the retrograde cardioplegia cannula placed?
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In the coronary sinus- Why is retrograde cardioplegia often used with severe coronary artery disease?
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It delivers cardioplegia distal to coronary stenoses or occlusions that could block antegrade flow- Where is a left ventricular vent typically placed during cardiac surgery?
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Through the right superior pulmonary vein into the left atrium and across the mitral valve into the LV- What ACT is generally required before initiating cardiopulmonary bypass?
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Greater than 480 seconds- What device stabilizes the heart during off-pump CABG (OPCAB)?
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A mechanical tissue stabilizer (e.g., an Octopus-type device) that immobilizes the target vessel- Which conduit is most commonly used to bypass the LAD?
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The left internal mammary artery (LIMA)- Why is the LIMA preferred as a conduit for the LAD?
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It has superior long-term patency compared to vein grafts- What cannulation setup is standard for an isolated aortic valve replacement?
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Ascending aortic cannulation distal to the planned aortotomy, with a single venous cannula- What venous cannulation strategy is used for mitral valve surgery?
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Bicaval cannulation with separate SVC and IVC cannulae- Why is bicaval cannulation necessary for mitral valve surgery?
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It allows caval snaring so venous blood does not flood the right atrium when it is opened for atrial or transseptal access- What is the purpose of caval snares (tourniquets) during bicaval cannulation?
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They occlude the cavae around the venous cannulae to prevent blood or air from entering an opened right atrium- Where is a left atrial vent commonly placed during mitral valve surgery?
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Through the right superior pulmonary vein or directly through the atriotomy
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