Total Arterial Re-vascnlarisation : In total arterial re-vascularisalion (TAR) end of the right internal mammary artery (RIMA) or radial arlery (RA) is anastomosed to the side of left internal mammary artery (LIMA) as a T or Y graft. This is done before cardio pulmonary bypass. On bypass, LIMA s anastomosed to diagonal branch as side-to-side and to LAD as end-to-side graft. Then sequential anastomoses between RIMA and OM1, OM2 or OM3 are done as side-lo-side anastomosed and it ends in PDA or KCA as an end to side graft.
Some patients may need ionotropic support of dopamine, dobutamine or adrenaline. In spite of ionotropic support, if blood pressure is low and LA pressure is high, insertion of intra aortic ballon pump (IAUP) is indicated.
After patient is weaned off cardio pulmonary bypass, cannulae are removed and heparin is reversed with protamine sulphate. Chest is closed with two drains. Patients are taken off ventilator after a few hours or next morning and if no complications intervene they should be back in the ward next day. They are ready to go home in 9 to 10 days.