Surgical Technique
IV midazolam 0.1 mg/kg, fentanyl 5 pg/kg, pancuronium bromide 0.1 mg/kg were used for anesthesia induction. When needed, 5 pg/kg fentanyl, 0.05 mg/kg pancuronium, or vecuronium bromide were used to maintain anesthesia. All patients underwent median sternotomy. The left internal thoracic artery and saphenous vein were used as graft. Heparinization ACT (Activated Clotting Time) was provided to over than 400 seconds. The CPB was performed by arterial cannulation through the ascending aorta and venous cannulation with two-stage cannula through the right atrium. Myocardial protection was provided with antegrade blood cardioplegia. Moderate hypothermia (28°C-32°C) was preferred. Roller pump and membrane oxygenator were used in all cases. The CPB was adjusted to keep pump flow to 2.2-2.4 lt/min/m2, mean arterial pressure 50-60 mmHg, and hematocrit 20-25% durding the aortic cross-clamp. After cross-clamping, CPB was discontinued after body temperature reached 36 ° C, cardiovascular stability was achieved and sufficient blood pressure was established.