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#1
03-22-2012, 10:44 AM
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Re-do sternotomy
)re-do median sternotomy
2)Attempted aorto-innominate carotid bypass graft surgery 3)Intraop EEG monitoring 4) Cardiopulmonary bypass standby Patient had a previous Type 1 aortic dissection in 1996 requiring replacemwnt of the ascending aorta ( Can this be 33530?) She had been ancef antibiotic pre-op in view of the fact that this is a re-do operation with the heart and aneurysm adjacent to sternotomy wound. The left common femoral artery and veins were dissected through an oblique incision in the groin and carried through the skin . We proceeded with median sternotomy incision. the sternal wires were removed. The sternum was divided with oscillating saw.The sternum was retracted. THere were dense adhesions. The ascending aorta innominate artery and vein and left carotid artery were dissected and vessel loops placed.I selected a 16x 8mm bifurcation graft to be utilized for bypass gfart and this was prepared.Partial occlusion clamp was placed on the ascending aorta at the graft.Multiple application at the siteof the partial occlusion clamp were applied in order to achieveadequate section of the graft;with such application the patient would deteriorate; requiring removal immediately of the graft.I began opening the graft, we concluded that it was not safe to perform the operation due to extensive amount of dissection of the remaining aorta.WE felt it was best to go ahead and stop the operation. THe sternum was closed with interrupted #5 and double stranded #6 sternal wires. I need some guidance . My codes are 35761(53), 21750(59) 
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