Patient: CARTER, PETER Account: CAR99336 Date: 2/1/XX Surgeon: Steven Broadbent, MD Preop DX: Severe coronary artery disease with unstable angina Posto

Patient: CARTER, PETER Account: CAR99336 Date: 2/1/XX Surgeon: Steven Broadbent, MD Preop DX: Severe coronary artery disease with unstable angina Postop DX: Same Anesthesiologist: Doug Smith, MD Anesthesia: General INDICATIONS: This is a 68-year-old male who underwent evaluation for severe coronary disease. Catheterization demonstrated severe triple vessel coronary disease with a subtotal right coronary artery and significant disease involving the left anterior descending, diagonal, and circumflex. We thought the patient could have four bypasses. The left anterior descending disease appeared diffused. Ventricular function was preserved. PROCEDURE: With patient in the supine position under general anesthesia, the chest, abdomen, groin and legs were prepped and draped in standard fashion. Saphenous vein was taken from the right leg and this wound was closed in routine fashion. Simultaneously, the chest was opened through a median sternotomy and the left internal mammary was prepared. The mammary was densely adherent to the back of the sternum at the top and we ended up dividing it at this point. The proximal end was over sewn with 3-0 Prolene and then with #2 silk and the mammary was prepared as a free graft. We then opened the pericardium and heparinized and cannulated the aorta and right atrium.