[HSF] "Patients don't want cardiopulmonary bypass" - the great con

[Tohru Asai]

Dear Z
A good question. I do not do the arterial sequentials when it is really
thin. So the sequential technique is not always feasible in all cases. In
sequential technique, we should be much more keen for length of the conduit,
its course, relationship of native size and conduit size ...etc. This should
be done only by a meticulous and thoughtful surgeon.

In another aspect, however I want to emphasize harvesting arterial conduit
skeletonized by using Harmonic scalpel all the way to the level under the
subclavian vein of great importance. Since I started this technique, the
right IMA almost always reaches very distal LAD in front and OM via oblique
sinus in "in-situ" fashion. Size is excellent. In summary, a meticulous
preparation really makes difference!
-- 
Tohru Asai


> Just one technique question, how do you do the sequential arterial anastomosis
> when the conduit is small.