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.