Today was a triple bypass CABG- nothing too out of the ordinary, but still a fun surgery to watch. I still want to see a VSARR (valve-sparing aortic root replacement), but those don’t seem to happen too often, which is a bummer. Digressions aside, before the case started, other surgeons called Dr. Nguyen to inform him of stenosis in the superior vena cava, one of the two venous pathways to the heart. It was a potential risk, but it must not have been serious enough, as they opted to continue. Most of what I saw was standard for CABGs; saphenous vein gets harvested from the left leg, the interior mammary artery gets one end detached, and both parts get grafted onto the coronary artery bed. The triple bypass, however, introduces an interesting twist on this familiar procedure- the saphenous vein is actually split in two for the arterial bypass. Instead of just linking the aortic arch to one artery, the saphenous vein bifurcates and leads to two spots on the heart. This is why the initial saphenous vein harvest is so long. It is divided into two parts, with each segment leading to different blockages in the coronary artery bed. This is all sorta complicated, so here’s a picture to explain it a bit better:
The saphenous vein, in its two parts, are the two white pieces on the right of the heart.Triple bypasses seem to take much longer than the doubles I'm used to seeing; the third piece of the graft takes some extra work to prepare for. But, I’m not sure how extensive the saphenous vein’s cleaning process is (wish I had seen it!).
I'll probably have some new stuff coming out soon about the Heartwell Project soon. School has just started, and I have a beginning-of-year retreat going on next week- so, I'll really just have to play it by ear until things get back to normal. I'm not sure how my time in the OR will fit into my new schedule, but my fingers are crossed for any morning but Friday (that's valve clinic/patient rounds, which just isn't as fun). Thanks for reading!
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