Coronary artery surgical technique.

The increased use of arterial conduits in coronary artery bypass grafting is reflected in numerous publications addressing indications, choice of conduits, and possible side-effects. Besides the internal thoracic artery, the right gastroepiploic artery is becoming established, and the inferior epigastric artery is being subjected to clinical trials. The latter conduit provides good patency and can be combined with the internal thoracic arteries, but harvesting must be done carefully to prevent local complications. Arterial conduits can lead to hypoperfusion, and additional saphenous vein grafting may become necessary; careful vasodilatation of the conduit before implantation is necessary. Xenografts and allogenic implants demonstrate poor late patency and should be used only as a last resort. Aprotinin reduces blood loss during surgery and seems to be particularly useful in reoperations; but it prolongs the activated clotting time and underheparinization can occur. Retrograde cardioplegia seems to be particularly indicated in reoperations, whereas topical cooling can be omitted. Coronary revascularization can be safely combined with carotid endarterectomy; the exact indication for this simultaneous procedure is still being explored.