
Author: Zivojin Jonjev
Nedavni intervju (podcast) u Univerzitetskom kliničkom centru Banja Luka, Republika Srpska.
Jutarnji program RTS-a 12.03.2024.
Coronary artery bypass grafting versus percutaneous coronary intervention in single-vessel left anterior descending artery disease: mid-term propensity matching study
Clipless skeletonized internal mammary artery harvesting with harmonic technology
Zivojin S Jonjev 1, Aleksandar M Milosavljevic 2, Novica Kalinic 3, Adam Adam 4
Affiliations
- 1Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina.
- 2Institute for Cardiovascular Diseases of Vojvodina, Clinic of Cardiovascular Surgery, Sremska Kamenica, Serbia.
- 3University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina.
- 4Icahn School of Medicine at Mount Sinai JJP VAMC, New York, NY, USA.
Free article
Abstract
Since the introduction of the mammary artery harvesting procedure, electrocautery has been used as a standard method of care. However, mammary artery spasm, subadventitial haematoma and mammary artery damage due to clips dispositioning or high thermal energy injury have been recorded. To achieve a perfect mammary artery graft, we propose the usage of a high-frequency ultrasound device, usually recognized as a harmonic scalpel. It reduces thermal-related injuries, the use of clips and the risk of mammary artery spasm and/or dissection.
Keywords: CABG; Conduit harvesting; Harvesting technique; IMA harvesting; Internal mammary artery.
© The Author 2023. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Kardiohirurgija u UKC Banja Luka
Bentall-De Bono aortic root reconstruction

A 61y/o Caucasian male was diagnosed with aortic root dilation (ST junction=5.5cm; Sinus Valsalve=5.9cm, AoAsc=5.6cm) with significant aortic valve regurgitation (3/4 degree). Aortic root was reconstructed with implantation of the composite graft (tubus+valve 25/28), and reimplantation of the coronary ostia into the composite graft. The patient was well and discharged 7 days after surgery.
ReReDo surgery due to acute aortic dissection
Acute aortic dissection (hemiarch repair in deep hypothermia)
Caucasian female 73 y/o was admitted to the hospital with acute aortic dissection. Transthoracic eco indicated that MR 4 and TR 3 were also present. After quick preop set up PT was urgently operated on. The dissected aorta was resected and hemiarch procedure was performed with implantation of the Vascutek #30 prosthesis. PT was in deep hypothermia (T=28C) and total circulatory arrest was established for 57 minutes. Brain was protected with cerebral anterograde perfusion through brachiocephalic trunk. MR and TR were also corrected by annuloplasty. The patient was discharged on the PO day #13 w/o complication. PT was doing well 3 month after surgery.
Preop view of the Aortic Dissection Arrangement of the proximal anastomosis with aortic cross clamp Tailoring of the graft and preparation for open distal anastomosis Final view after surgey
Papillary muscle rupture after acute myocardial infarction
The patient was admitted to the hospital soon after diagnosis of the acute myocardial infarction, complicated with cardiogenic shock. The patiend was former Olimpic Champion in hanball and was in an excelent physical condition. The cath. lab confirmed triple vessel disease and the patient was transferred to the operating room. The patient was operated on with triple CABG. RCA was grafted with saphenous venin and LAD/D1 was grafted with LIMA in a “jumping” fashion. Mitral valve was replaced with Carbomedics 27 bileaflet prosthesis, and the tricuspid valve was reconstructed with stitch annuloplasty. The patient did well after surgery and was discharged on the PO 11 in a good health condition.
