[HSF] off-pump CABG and mesenteric ischemia

[erdinç naseri]

Ani,
1. Postop she had 2 bouts of atrial fibrilation which were self terminated and the patient was anticoagulated all the time with ACT>200 seconds.And we started prophylactic amiodarone infusion
2.I forgot to mention that about 1 hour before the final deterioration and second lap she developed hypotension and low urine unresponsive to drugs and despite the report of good cardiac action on echo I put IAB cath in the contraleral femoral artery but not before that.
3. She was a very obese lady (BMI>45,or somewhere there) with brachial artery cath in the R arm and each time I trusted on her from surgeons position it was damped which made me uncomfortable  while doing the OM anastomosis . To have a better invasive BP monitoring we put  a cath in the R femoral artery .Also in our clinic we do use femoral artery oftenly.
4.She had a history of COPD and one  of my colleagues took a thoracic CT which revealed calcifications around the arch and mid descending aorta.
5.The aorta was not diseased macroscopically and I constructed 2 proximals with 2 times side biting clamping and the other 2 saphenous veins on top of the others ( which I often use specially if age > 70,average life expectancy around 67 here)
6.As I learned retrospectively ( and unfortunately) she had been constipated prior to surgery (no defecation in the hospital and god knows from when).I also forgot to tell that the surgeon made a rectal exam and then enema and a rocky hard feces of about a tennis ball ( fragmneted )
7. HIT was not considered ( nl platelet number)
erdinc