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AA - Cardiac surgery COPY > Coronary Surgery > Flashcards

Coronary Surgery Flashcards

1
Q

STICH Trial Primary Endpoint and Results

A
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2
Q

Indications for SVR (Surgical Ventricular Restoration)

A
  1. Refractory NYHC III or IV CHF
  2. LVEDD > 75mm
  3. LVESVI > 60mL/m2
  4. LVEDVI > 100mLm2
  5. Previous Anterior MI with Non-Viability
  6. LV Dysfunction with Regional Asynergy (akinesis/dyskinesis) >35% of the LV
  7. Ventricular Arrhythmias
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3
Q

Contraindications for SVR (Surgical Ventricular Restoration)

A
  1. Severe PHTN
  2. Severe RV Failure
  3. Anterior LV Viability
  4. Restrictive LV (small LV)
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4
Q

Benefits of using bilateral internal mammary arteries?

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5
Q

Benefits of using the LIMA?

A
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6
Q

Benefits of multi-arterial grafting?

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7
Q

Postop CABG: Causes of mortality?

A
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8
Q

CABG:

Chronic total occlusion/characteristics of:

A
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9
Q

CABG for LV dysfunction

A
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10
Q

CABG for Survival: Indications

A
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11
Q

CABG for Symptoms: Indications

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12
Q

CABG in Diabetics

A
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13
Q

Indications for CABG?

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14
Q

Mortality after CABG

  1. Highest
  2. Lowest
A
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15
Q

CABG Timing:

  1. Stemi
  2. When should be delayed after STEMI
  3. Recurent ischemia or infarction
  4. Stable patients
A
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16
Q

CABG’s effect on LV function?

A
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17
Q

Name the 8 cardiac operations for which an STS risk score can be calculated?

A
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18
Q

Name the post-MI rupture syndromes?

A
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19
Q

Coronary endarterectomy:

  1. Indications
  2. Mortality
  3. Perioperative MI
  4. Compared to CABG w/o endarterectomy
A
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20
Q

Transmyocardial revascularization:

  1. Description of operation
  2. Effect on:
  • Angina
  • Exercise tolerance
A
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21
Q

Measure of a significant stenosis on:

  1. FFR
  2. iFR
A
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22
Q

Pedicled vs skeletonized IMA?

A
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23
Q

Indications for CABG after prior CABG

A
24
Q

Indications for CABG in stable ischemic disease

A
25
Q

Indications for CABG when having ventricular arrythmias?

A
26
Q

Indications for CABG after failed PCI

A
27
Q

Indications for CABG in patients with a reduced EF?

A
28
Q

Indications for EMERGENT CABG?

A
29
Q

IVUS: minimum luminal area

  1. Non- left main vessel
  2. left main
A
30
Q
A
31
Q
A
32
Q
A
33
Q
A
34
Q

Patency rates of bypass conduits?

A
35
Q

Pathophysiology of a MI

A
36
Q

Indications for PCI?

A
37
Q

Radial artery conduit characteristics:

  • Spasm propensity compared to IMA
  • The medication most effective for spasm
  • Patency in relation to:
    1. % stenosis
    2. left vs right side
    3. proximal anastomosis: direct to aorta or off vein?
A
38
Q

Re-do CABG vs PTCA:

  • Factors that favor CABG
  • Factors that favor PTCA
  1. Stenosis: late Vs early
  2. # of stenotic grafts
  3. Graft to LAD
  4. Ejection fraction
A
39
Q

Indications for a re-operative CABG?

A
40
Q

SVG Characteristics?

A
41
Q

Strategies for a safe reoperative CABG?

A
42
Q

Top 3 STS variables associated with morbidity?

A
43
Q

Top 3 STS variables associated with mortality?

A
44
Q

MI: Contraindications to thrombolytics

A
45
Q

MI: Indications to use thrombolytics

A
46
Q

Timing of CABG after MI

  1. STEMI
  2. NSTEMI
A
47
Q

What is the TIMI risk score and what is it used for?

A
48
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for asymptomatic patients?

A

Left main stenosis, left main equivalent (proximal LAD and circumflex), 3v dz, 2v dz including prox LAD + LV dysfx.

49
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for symptomatic patients with non-STEMI?

A

2-vessel disease not involving LAD if large area of myocardium involved. Single-vessel disease if LAD if associated with extensive ischemia and LV dysfunction. Should be done before DC.

50
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for STEMI?

A
  • Failed angioplasty w/ persistent pain or hemodynamic instability. - Persistent uncontrollable angina w/ acceptable vessels and large amount of myocardium at risk. - Mechanical complications of STEMI (LV rupture, VSD, and/or acute valve insufficiency). - Cardiogenic shock w/ myocardium at risk. - Recurrent or life-threatening arrhythmias w/ left main or triple vessel disease.
51
Q

In general, patients with coronary artery disease, good ventricular function, minimal symptoms, and limited myocardium at risk should be initially be treated with what?

A

Best medical management.

52
Q

In general, patients with CAD who have symptoms that compromise quality of life should be treated with what?

A

Revascularization (should be considered). CABG appears to be lower risk of mortality compared to PCI in most patients w/ DM and complex multi-vessel disease.

53
Q

What is fibrillatory arrest with CPB?

A

Similar to on-pump beating heart surgery, but induced V fib provides non-beating operative field. Induced w/ T <30C or metal clips attached to AC current. LV sump/vent required to prevent LV distention. Distal anastomosis before proximal if heart beating. Distal anastomosis can be done under fibrillatory, but cooling is required to protect the heart, especially w/ LV hypertrophy.

54
Q

What are advantages of cardiac arrest w/ CPB?

A

Bloodless field, flaccid heart, diastolic arrest, well protected. Myocardial protection is the key component - del Nido solution.

55
Q

How long is del Nido effective for aortic cross-clamping?

A

90 minutes.

56
Q

What is the typical pattern of multi-vessel anastomosis in CABG w/ cardiac arrest?

A

Less important, but typically distal to back of the heart (RC system), lateral wall (circ), LAD, then proximal anastomoses.

AA - Cardiac surgery COPY (29 decks)

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