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Flashcards in Anesthesia for Cardiothoracic Procedures Deck (154)
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1

3 types of Cardiothoracic surgery

1. open heart surgery (sternotomy/ thoracotomy)
2. Da Vinci (laparoscopic)
3. endovascular (valve repair/ aortic repair)

2

What does "invasive" cardiac surgery refer to?

sternotomy
-best exposure but most possible complications

3

3 cardiac surgeries considered minimally invasive

1. Da Vinci
2. Thoracotomy
3. Endovascular

4

Minimally invasive cardiac surgery is aka?

MICS

5

What kind of endotracheal tube may be used in a MICS?

Double lumen
-one of the lungs may need to be deflated

6

Can MICS be performed "off pump"?
Bypass can be instituted with cannulation through which vessels?

Yes;
femoral vessels

7

Which is more common for Aorta surgery?
1. Invasive open repair with cross clamps
2. minimally invasive endovascular repair

2. minimally invasive endovascular repair

8

How is a MICS CABG performed?
1. what incision?
2. commonly performed on or off pump?

1. thoracotomy incision
-reserved for 1 or 2 vessel disease due to limited exposure of anterior vessels

2. off pump
-bypass via femoral vessels can be an option

9

in a DaVinci CABG procedure, what is the main purpose of the robot?

to harvest the LIMA

10

in a DaVinci CABG procedure, after the LIMA is harvested, how is the graft sewn on?

Through a small thoracotomy incision

11

an operation in which the anterior vessels are bypassed with a MICS/thoracotomy approach (by a cardiac surgeon) and the more difficult to expose vessels are stented (by an interventional cardiologist)

Hybrid coronary revascularization

12

What is the benefit of Hybrid coronary revascularization?

allows multiple CAD to be performed without sternotomy while still allowing a LIMA to LAD graft
-superior to intravascular stent placement

13

Hybrid rooms are utilized for which 2 procedures?

1. hybrid coronary revascularization
2. transcatheter aortic valve replacement/ transcatheter aortic valve implantation

14

Hybrid rooms are utilized for procedures that use which 2 types of doctors?

1. cardiac surgeon
2. interventional cardiologist

15

Because CABG patients have CAD, the goal is to avoid which two occurrences?

Do we premedicate for CABG patients?

1. anxiety
2. tachycardia

Yes: Give higher dose of Midazolam

Patients undergoing CABG require heavier medication than valve replacement

16

Are stenotic heart valves typically replaced or repaired

replaced
-leads to better outcomes

Repairs involve removal of calcifications

17

Are regurgitant heart valves typically repaired or replaced?

Repaired
- although both repaired and replaced can be done

18

Do we premedicate for valve repair/replacement patients?
why or why not?

NO:
Premedication can lower blood pressure and cause vasodilation = reduced preload and afterload

Patients for valve repair need to maintain preload/afterload

19

In MICS valve repair/replacement surgeries:

are they most commonly performed On or Off pump?

If on pump, where are the cannulation sites?

on pump
femoral vessels

20

Can valve repair/replacments be done with the Da Vinci robot?

yes
-bypass is possible via femoral vessels

21

What are 6 surgical ways in which valves may be repaired or replaced

1. MICS
2. Da Vinci
3. Endovascular (off pump)
4. Full Bypass with an arrested/beating heart
5. Right heart bypass for pulmonic/tricuspid valves
6. Transapical (off pump)

22

When would we consider using an endovascular valve repair technique?

in patients who do not qualify for open heart surgery

23

Endovascular aortic valve replacement is referred to as what 2 names?

1. Transcatheter aortic valve replacement (TAVR)
2. Transcatheter aortic valve implantation (TAVI)

24

What are the 2 catheter/stent pathways for TAVR and TAVI?
Which is most common?

1. femoral artery to aortic valve (most common)
2. axillary artery to aortic valve

25

What is the catheter/stent pathway for endovascular mitral valve repair?

femoral vein to intra-atrial septum to mitral valve

26

What is the catheter/stent pathway for tricuspid and pulmonic valve repair?

femoral vein, passes through the right side of the heart to the valve

27

A form of TAVR/TAVI that is the only example of a valve replacement being performed “off pump” with an “open” approach

Transapical valve replacement

-mini thoracotomy

28

6 risks associated with Endovascular TAVR

1. Associated with a higher risk of this compared to surgical replacement

2. What type of leak?

3. the most frequent adverse outcome associated with TAVR and can lead to life threatening hemorrhage

4. risk is due in part to the large contrast load used in placing the valve with fluoroscopy

5. What type of cardiac conduction abnormalities?

6. What type of post op complications?

1. stroke/ TIA

2. perivalvular leak
-aortic regurge

3. vascular complications
-perforation, dissection, rupture in the arteries

4. Acute kidney injury

5. mechanical impingement of the conduction system leading to LBBB
-complete heart block in patients with existing RBBB

6. bleeding and atrial fibrillation

29

What approach can limit vascular complications during Endovascular TAVR be limited?

transapical thoracotomy approach

30

anesthetic management of TAVR

1. What 2 things should be administered for Renal Protection (because of contrast dye used)

1. perioperative volume loading
-administration of N-acetylcysteine prior to surgery