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Flashcards in Cardiac Surgery Concepts Deck (259)
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1

the name of the procedure that restores normal blood flow to an area of the heart by creating new routes around obstructive coronary arteries

coronary artery bypass graft (CABG)

2

what are the 3 blood vessels that can be harvested from the body for a CABG?

1. Left internal mammary artery (LIMA)

2. saphenous vein

3. radial artery

3

Where is the graft for the CABG sewn in relationship to the atherosclerotic coronary artery?

Proximal and distal to the atherosclerotic coronary artery

4

Where is the proximal anastomosis of the CABG graft located?

on the aorta

5

Where is the distal anastomosis of the CABG graft located?

on the coronary artery; distal to the obstruction

6

in a triple bypass, how many distal anastomoses and proximal anastomoses will there be?

3 distal and one proximal

7

in a CABG, the amount of distal anastomoses will always be _____ (higher/lower) than the amount of proximal anastomoses

higher

8

in a CABG procedure, which anastomoses does the surgeon usually sew on first?
proximal or distal

distal; so when the surgeon is done sewing the distal anastomoses the procedure will be done soon because there are usually less proximals to do

9

which vessel is the most commonly used graft for CABG?

LIMA ( Left Internal Mammary Artery)

10

Which vessel is the LIMA most commonly anastomosed with?

LAD ( left anterior descending)

11

During CABG (arterial/venous) grafts are preferred over (arterial/venous) grafts.

Why?

arterial
venous
- the grafted vessel has to carry arterial blood and not venous blood
-coronary arterial pressure will damage the saphenous endothelium more quickly

12

LIMA patency rates are 90%, saphenous patency rates are 60%, and radial artery patency rates are lower than LIMA over a period of 10 years. Why does LIMA have the highest?

LIMA is a "live" graft which means that its proximal origin from the subclavian is left intact

13

What does the acronym PCI stand for?

Percutaneous Coronary Intervention

-Balloon Angioplasty and Cardiac Stenting

14

What procedure is used as an alternative to CABG, is less invasive, and is used for less severe cases of coronary artery disease?

Cardiac stenting

15

(CABG/Cardiac stenting) tends to show better 5 year survival and patency rates?

CABG

16

(CABG/ Cardiac stenting) carries a higher risk of stroke after 5 years

CABG

17

Newer stents are called "____- ______" stents
What do these stents do?

drug-eluting
-they slowly release a drug in order to slow the narrowing process

18

A cardiopulmonary bypass machine (CBM) functions as both the _____ and ______

heart
lungs

19

What are the 4 ways the cardiopulmonary bypass machine acts as the heart and lungs?

1. drains deoxygenated blood from the body

2. Oxygenates the blood

3. Removes the CO2

4. Pumps oxygenated blood back into the body

20

What are the 2 primary reasons a surgeon would use the cardiopulmonary bypass machine?

1. Stop the heart
-so the surgeon can work on a heart that isn't moving

2. Drain the blood out of the heart
-so the patient will not bleed out as the heart is opened

21

Name a surgery where the heart would need to be drained of blood and cardiopulmonary bypass would have to be used

open valve repair

22

Is it mandatory for the heart to be arrested during cardiac surgery?

no
-some operations do not require it, however surgeons will do it anyway because it is easier to operate on a non-moving target

23

Is it mandatory for the heart to be arrested during cardiopulmonary bypass?

no
-it is most common, however it is possible for the heart to remain beating

24

what solution do surgeons inject into the heart to arrest the heart?

Cardioplegia

25

What is Cardioplegia made up of?

potassium rich solution
-can contain additives such as glucose, magnesium, calcium, bicarb, buffers, and free radical scavengers ( mannitol)

26

What is another way cardioplegia can be administered

mixed and injected with blood

27

the most common way of arresting the heart is to inject cardioplegia into the _____ ______ through the ______ ______

coronary arteries
coronary ostia (os)

28

When cardioplegia is injected into the coronary arteries, it is referred to as "_______ ______"

antegrade cardioplegia

29

most commonly antegrade cardioplegia is injected into the _____ ______

aortic root through a cardioplegia cannula

30

What is necessary to put on the ascending aorta during antegrade cardioplegia?
What is its purpose?

cross clamp
prevents the cardioplegia from washing out into the body and contains it in the heart