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Lateral wall revascularization
SOP » Surgery protocol » Lateral wall revascularization
Last modified on Tue 15 Jul 2014

The suction stabilizer is most frequently clamped to the inferior right side of the retractor. Consequently, the arms of the stabilizer will point in the same direction as the lateral vessels. This reduces the amount of pressure applied by the device to the myocardium. The stability of the arm depends on the distance between the anastomotic region and the anchor point on the retractor; the shorter the distance, the stiffer the arm is. For more proximal branches of the circumflex, an anchor point on the left side of the retractor can be used. The same principles of stabilization of the anterior vessels apply here. The target is exposed and the graft is prepared. Length is carefully measured from the planned proximal site on the mammary artery to the lateral wall. If a target is planned for the inferior wall, a similar measurement is taken distally. The opening in the graft is made and the anastomosis is completed, occluding both ends of the conduit before the completion.
Ordinarily the next step is to complete revascularization of the inferior wall. However, in the event of ongoing ischemia or tight left main disease, the proximal anastomosis to the mammary artery should be completed first, to allow new blood flow to the suffering myocardium.