CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 AFRICA 243 patients. With this technique, the diastolic filling (DF), mean flow and pulsatility index (PI) can be measured (Fig. 1). Based on the data from similar studies and recommendations from the manufacturer, we accepted the PI value as the main criterion for flow quality. We performed additional interventions on the grafts with a PI value of ≥ 5. The decision for additional interventions was made according to the values that were obtained prior to protamine infusion. All grafts were measured from at least two segments and were evaluated by averaging. Although the decision for additional interventions was made according to the pre-protamine data, intergroup comparisons were made according to the post-protamine data. For surgery, the patients in all groups were anaesthetised with standardised anaesthetic agents at our clinic. The mediastinum was reached by performing standard incisions and median sternotomies in all patients. Due to the number of vessels that required surgery and the number of grafts that would need to be used, left internal mammary artery (LIMA) and saphenous vein grafts were prepared. Coronary bypass was performed on all patients in groups 1 and 2 using standard CPB. Patients in group 3 underwent surgery on the beating heart without entering the pump. Ascending aorta cannulations and right atrial two-stage venous cannulations were performed on all patients to proceed with CPB. Roller pumps and membrane oxygenators were used. Cardiac arrest was induced with antegrade cardioplegia after cross-clamping for myocardial protection in CPB, and distal and proximal anastomoses were performed under cross-clamping. Myocardial protection was achieved by repeated cardioplegia every 20 minutes until the anastomoses were completed. Body temperatures were lowered to 30–32°C. In group 2, the patients underwent ascending aorta cannulations and right atrial two-stage venous cannulations, but the anastomoses were performed without cross-clamping and cardioplegia. The Octopus was used in the anastomoses performed on the beating heart without CPB. KDC ANA BILIM DALI Surgeon: Operation Date: Patient Name: Comments: Patient ID: Birthdate: 10/09/1956 Gender: Male Height: 165 cm Weight: 70kg 04/12/2017 10:09:07 10s 04/12/2017 10:08:07 10s 04/12/2017 10:08:47 10s ml/min 150 100 50 0 ml/min –150 –100 –50 0 ml/min 150 100 50 0 Q1 –50 mV 100 50 0 ECG 50 Q1 –50 mV 100 50 0 ECG 50 Q1 50 mV 100 50 0 ECG 50 14 % 4 mm 33 % 4 mm 10 % 4 mm Fig. 1. Sample transit time flow measurement screen.
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