02.18a Surgical Management of CAD Flashcards Preview

Cardiology > 02.18a Surgical Management of CAD > Flashcards

Flashcards in 02.18a Surgical Management of CAD Deck (41):
1

Etiology of CAD

Atherosclerosis

2

Risk factors of CAD

Age
Cigarette smoking
HPN
Dyslipidemia
Sedentary lifestyle
Obesity
DM

3

How to prevent CAD according to Class 1 recommendations by the ACC and AHA

Smoking cessation
BP < 140/90 (130/80 for DM or CKD)
LDL < 100
ASA therapy
BMI < 25
DM management HbA1c < 7%
Daily exercises

4

Clinical manifestations of CAD

Angina pectoris
MI
Ischemic heart failure
Arrhythmia
Sudden death

5

Clinical evaluation of CAD

Lab work-up
Chext x-ray
12-lead ECG
Stress test (Stress Echocardiography)
2D echocardiography
Coronary angiography

6

Have the ability to assess global ventricular function in terms of LV ejection fraction which can be used to determine operative risk

Stress echocardiography

7

Primary diagnostic tool for CAD

Coronary angiography

8

Normal LV ejection fraction

0.55-0.70

9

Mild depression level of LV ejection fraction

9

10

Moderate level of LV ejection fraction

< 0.4

11

Severe level of LV ejection fraction

< 0.25

12

Evidence and or general agreement that procedure is beneficial, useful and effective

Class I

13

Conflicting evidence

Class II

14

Conflicting evidence in favor of usefulness or efficacy

Class IIA

15

Conflicting evidence in favor of not being useful

Class IIB

16

Evidence and or general agreement that procedure is not useful or effective and may be harmful

Class III

17

Significantly higher rates of repeat revascularization in _____

PCI than CABG

18

Most important criterion in conduit selection

Graft patency

19

Conduit with highest patency rate

Internal thoracic artery

20

Vessels used for conduit

Internal mammary artery
Saphenous vein graft
Radial artery
Gastroepiploic artery

21

How to harvest saphenous vein

Conventional vein harvesting
Endoscpic vein harvesting

22

Open technique, incision is made along the course of the vein on the medial aspect of the lower extremity

Conventional vein harvesting

23

Starts with a small incision just above and medial to the knee where the endoscope is inserted

Endoscopic vein harvesting

24

In using radial artery, confirm ulnar collateral flow to the hand by

Allen's test
Duplex ultrasound study

25

In harvesting radial artery, incision is made point near the _____

radial styloid process ending just medial and distal to the biceps tendon on the non-dominant hand

26

To preserve myocardium, a temperature of ____ is needed

28 - 33 dec C

27

Types of cardioplegic solution

Crystalloid
Blood

28

Recommended to revascularize the area with the most concern for ischemia then give cardioplegia down the completed graft

Retrograde cardioplegia

29

In LAD graft, this is performed last to avoid kinking or disruption of bypass

Left internal thoracic artery

30

Does not make use of the heart-lung machine
Done to avoid the adverse consequences of cardiopulmonary bypass
Heart is left beating through myocadial stabilization devices for immobility while anastomoses are being done

Off-pump coronary artery bypass (OBCAP)

31

One internal mammary and the rest are veins

Single IMA CABG

32

Arteries still come from internal mammary artery
Higher success rates

Bilateral IMA CBG

33

Fats in the vein are left behind and grafted

No touch saphenous vein technique

34

Saphenous vein solution

Nitric oxide synthase

35

Minimal incision, but maximum difficulty
Done through a left anterior mini-thoracotomy through which mobilization of the left internal thoracic and direct anastomosis to LAD is performed
Done to single-vessel disease

Minimally invasive direct coronary artery bypass (MIDCAB)

36

Surgery may perform the procedure from another place, through the use of consoles
Expensive

Total endoscopic coronary artery bypass (TECAB)

37

Similar to catheterization lab but it also serves as an operating room
Provides catheterization, agiography, CABG

Hybrid coronary revascularization

38

Puncture the myocardium and expose to laser
Candidates are those not allowed for stenting, angioplasty or bypass

Transmyocardial laser revascularization

39

Used for patients with end stage coronary artery disease
No longer recommended

Transmyocardial laser revascularization

40

Regenerative medicine and tissue engineering

Cardiac stem cell theray

41

Alternatives to CABG

Off-pump coronary artery bypass
Multiple arterial coronary revascularization
Minimally invasive direct coronary artery bypass
Total endoscopic coronary artery bypass
Hybrid coronary revascularization
Transmyocardial laser revascularization
Cardiac stemm cell therapy