[HSF] Access to AV groove area post bypass

[Tohru Asai]

Dear Yadav
What I have been doing is to check all posterior hemostasis just prior to
termination of CPB. I mean flow of CPB to be about 500 cc/min when systemic
blood pressure is almost the same to post-CPB. Therefore we can see any
bleeding in the same condition to post CPB, some bleeding points are often
not clearly seen with full CPB support and non-pulsatile status. Basically
this maneuver should be done in all CPB cases prior to its termination, I
guess.

However there may be bleeding post CPB. Since I started beating heart
bypass, I feel surprisingly easier to put additional stitches in OM
anastomosis whenever needed, even though rarely happened. First I pull the
left edge of percardium a little tighter. Then I make the table head down
and rotate toward the operator. And with watching hemodynamic monitoring, I
put my left hand behind the heart and gentry verticalize the heart.
Hopefully it will take care of your difficulties.

-- 
Tohru Asai