Also, the proximal part of a conduit can be anastomosed to the side of another conduit (by a Y or a T anastomose) adding to the versality of options for the architecture of CABG. It is preferred not to harvest too much length of conduits  since it might cause some patients to need re-operation. With CBP (on-pump)
The patient is brought to the operating theatre, intubated and lines (e.g., peripheral IV cannulae; central lines such as internal jugular cannulae) are inserted for drug administration and monitoring. The traditional way of a CABG follows:

HarvestingA sternotomy is made, while conduits are being harvested (either from the arm or the leg). Then LITA (formerly, LIMA) is harvested through the sternotomy. There are two common ways of mobilizing the LITA, the pedicle (i.e., a pedicle consisting of the artery plus surrounding fat and veins) and the skeletonized (i.e., freed of other tissues). Before being divided in its more distal part, heparin is administered to the patient via a peripheral line (for clot prevention). Catheterization and establishment of cardiopulmonary bypass (on-pump)After harvesting, the pericardium is opened and stay sutures are placed to keep it open. Purse string sutures are placed in aorta to prepare the insertions of the aortic cannula and the catheter for cardioplegia (a solution high in potassium that serves to arrest the heart). Another purse string is placed in right atrium for the venous cannula.
The discrepancies in the practitioners’ knowledge, family resources, and differences in patients culture and/or residency have played a part in the outcome of the patient. Prognosis
DSMA1 is usually fatal in early childhood. The patient, normally a child, suffers a progressive degradation of the respiratory system until respiratory failure. There is no consensus on the life expectancy in DSMA1 despite a number of studies being conducted. A small number of patients survive past two years of age but they lack signs of diaphragmatic paralysis or their breathing is dependent on a ventilation system. Research directions
The disease has only been identified as distinct from SMA recently, so research is still experimental, taking place mostly in animal models. Several therapy pathways have been devised which include gene therapy, whereby an IGHMBP2 transgene is delivered to the cell using a viral vector, and small-molecule drugs like growth factors (e.g., IGF-1 and VEGF) or olesoxime. Studies in amyotrophic lateral sclerosis are also considered helpful because the condition is relatively similar to DSMA1. See also
Distal hereditary motor neuropathies
Spinal muscular atrophies
Spinal muscular atrophy

References
Further reading


== External links ==