Standard bypass operating procedure

Surgical access is normally obtained by opening the breastbone through what is known as a midline longitudinal sternotomy. For a conventional operation, extracorporeal circulation (ECC) using a heart-lung machine (HLM) is necessary, i.e. cardiac arrest (cardioplegia) and cooling of the patient (hypothermia to 28 - 32^oC), via a connection to the ascending aorta and right atrium. This procedure using ECC is a standard and high-quality method, especially when there is a greater number of bypasses and when they are to be joined to severely calcified, poorly accessible and small coronary arteries. The connections (anastomoses) are sutured end-to-side or side-to-side using an extremely fine thread (7/0 polypropylene suture) to the longitudinally opened coronary artery either singly or sequentially (several anastomoses in succession); LIMA and vein bypass grafts are usually necessary at the same time as multivessel disease is usually present. The vein grafts are then anastomosed to the ascending aorta with the heart beating again (cutting down ischaemia time). At the end of the operation, the opened breastbone is closed again with wire cerclages. The wires are left in place permanently and the breastbone is stable again after 6 weeks. Postoperative course: one and a half days in the intensive care unit (this is run by specialist anaesthetists and cardiac surgeons), and one week in an ordinary ward. This is followed by two to four weeks in a rehabilitation clinic. Coronary patients are followed up by their family doctor and the cardiologist. Patients with extreme disorders of lipid metabolism can be helped in our clinic with the H.E.L.P. procedure ("cholesterol washing").