Surgical Technique
All CABG procedures were performed by the same surgical team in a
standardized fashion utilizing an on-pump technique. Arterial and venous
catheters were inserted into the radial artery and right jugular vein
before sternotomy. Blood pressure, central venous pressure, urine output
and oxygenation were monitored throughout the surgery. All patients
underwent standard median sternotomy under general anesthesia. Grafts
were prepared after heparinization (300 IU/kg). After placement of the
Favalaro retractor, LIMAs were harvested in the form of pedunculated
grafts in all patients by the use of electrocautery and hemoclips.
During and after harvesting of LIMAs, a warm papaverine solution was
used to prevent LIMA spasm. Following the performance of side-to-side
LIMA and SVG anastomosis, coronary flow in the distal LAD was checked
and side-to-end LIMA-LAD artery anastomosis was carried out using 8-0
prolene sutures. Saphenous Vein Grafts (SVGs) were harvested
endoscopically and were grafted to the coronary arteries by employing
the end-to-side anastomotic technique. An epicardial pacing wire was
then positioned on the anterior cardiac surface and mediastinal and
thoracic cannulas were placed for drainage. The sternum was closed by
surgical steel wires as a complete layer. 4-0 vicryl was used for skin
and subcuticular closure. Following the operation, patients were
transferred to the intensive care unit (ICU) and received enoxaparin 0.1
mg/kg twice daily for three days. From the first postoperative day, all
patients received a lifelong daily maintenance dose of 100 mg of
aspirin.