Cardiac surgery procedures

Steps for Cardiac Surgery:

  • Arrange the trolley for CABG.
  • Painting and draping- The area of surgery is cleaned throughly with betadine solution. After that the surgical fluid is isolated from other areas with drapes.
  • Incision site is cleaned with spirit, then one meter sheet to dry it.
  • Place IOBAN at incision site.
  • Apply light handles on the light.
  • Ready cautery and suction


  • No 3 SUTUPAK for marking
  • BP handle with 21 no blade for skin incision with one large sponge.
  • After that cautery for cutting soft tissues
  • For suprasternal space use Czerney, vascular forces and cautery.
  • Use Syringe needle to locate midline for parasternal both sides.
  • Pericardium and pleura are separated by fingers.
  • Use heavy scissor for cutting xiphoid process.
  • Use sternal saw for sternotomy.
  • Use large sponge and apply bone wax in the bone marrow to control bleeding.
  • Both the tables of the sternum cauterised.
  • Use chest retractor.
  • Use bone wax for upper 1/3rd of the sternum.

Internal Mammary Harvesting:

  • Place IMA retractor.
  • First separate the endothoracic fascia over the IMA with the help of cautery and vascular forces.
  • Start harvesting the pedicled IMA using force and cautery.
  • Use Clip and dry gauze piece.
  • Once harvesting is completed use 7 inch artery forcep for clamping IMA and then use metzenbaum scissor for cutting it.
  • Check blood flow and use bull dog.
  • Use Papaverine cause for covering IMA to prevent spasm.
  • Use SUTUPAK to tie the distal already clamped artery. Use metzenbaum scissor to cut the suture.
  • Check for bleeding in the IMA harvesting site, achieve homeostasis if any and remove IMA stand.
  • Use hot and wet sponge for mopping and place chest retractor.


  • Use vascular forcep with cautery.
  • Use 2 kocher’s for left side.
  • Remove chest retractor.
  • Use 2 large sponge on both sides and place chest retractor and remove kochers.
  • Pericardial stay application with no 3 SUTUPAK using golden handle needle holder with vascular forcep. Use curved artery forcep to hold it to the green sheet.

Purse String:

  • Use 3-0 Prolene with golden handle needle holder with vascular forcep for aortic purse string and cannulation.
  • Cut the needle with metzenblum scissor and use snugger with rod to secure the purse string in place using a curved artery to hold it.
  • Use 3-0 proline with older handle needle holder with vascular forcep for venous cannulation.
  • Cut the needle with metzenblum scissor and use snugger and curved artery to hold the suture.

Mammary preparation-

  • Octopus, mist blower should be ready.
  • Use coronary instrument.
  • Take 25 cm sheet
  • Use ring forcep and metzenbaum scissor.
  • Use forward scissor to cut as appropriate.
  • Use dilator. 1mm first then 1.5mm.
  • Use ligature clip and remove bulldog.
  • Use metzenbaum scissor then tenotomy scissor.
  • Use bulldog
  • Use 2 mosquito forceps
  • Use ring forcep and forward forcep.
  • Use dilator 1mm and 1.5mm.

Vein Preparation-

  • Use 25 cm sheet.
  • Take vain with vein-filler with syringe.
  • Use tenotomy if needed.
  • Use ring forcep and metzenbaum scissor.
  • Use forward scissor to cut vein.
  • Keep it back in bowl.


  • Use hot and we sponges to elevate the heart.
  • Use octopus, make suction on and tighten it.
  • Use Gerald forcep with no 15 blade to make the artery visible properly. Use bulldog.
  • Use no 11 blade to give nick on the artery. Take forward scissor to cut as appropriate.
  • Use shunt.
  • Take vein with mosquito.
  • Use 7-0 proline suture.

Proximal anastomosis-

To be written…