Cardiovascular management after surgery

Question 1

Preparing family

Answer 1

Prepare family for what the pt will look like in ICU

• tubes, drains, not able to talk
• time frames

Question 2

Preoperative assessment for cardiac

Answer 2

• CXR, urine sample, ECG, nasal and groin swabs
• Any necessary consults e.g renal, endocrine
• Spirometry
• Height and weight
• Allergies
• Temperature, heart rate, resps, blood pressure
• Capacity for ADLs, mobility
• Recent infections
• Bowel habits
• Falls risk assessment
• Pressure risk assessment
• Discharge planning

Question 3

Indications for coronary artery bypass grafts

Answer 3

• triple vessel disease
• left main disease
• failure angioplasty

Question 4

Cardiopulmonary bypass allows:

Answer 4

• the heart to be stopped
• blood to be warmed or cooled
• oxygenation and pumping of blood continue
• the longer the
  surgery the more complications

Question 5

Benefits of full cardiopulmonary bypass

Answer 5

• comfortable for surgeon
• bloodless field
• heart doesn’t move during surgery
• myocardial protection
• access to all vessels for total revascularisation

Question 6

Risks of full cardiopulmonary bypass

Answer 6

• aortic cannulation
• cerebral emboli
• dissection
• complications of bypass

Question 7

Off bypass coronary artery grafting

Answer 7

done on warm, beating heart

• Eliminates complications of cardiopulmonary bypass
• Eliminates need to cross clamp aorta
• Potentially reduces transfusion rates
• Potentially reduces cognitive dysfunction
• Suturing more difficult

Question 8

Graft harvest sites

Answer 8

• left internal mammary (LIMA) - used to higher pressure so can withstand pressure
• Saphenous vein - easily accessible
• Radial artery - possible vasospasm

Question 9

Valve anatomy

Answer 9

• Tricuspid valve: between right atrium and ventricle
• Mitral valve: between left atrium and ventricle
• Aortic valve: between left ventricle and aorta
• Pulmonary valve: between right ventricle and pulmonary artery

Question 10

Valve Pathology

Answer 10

• Normal aortic valve leaflets
• Vegetations from endocarditis
• Mitral stenosis
• Floppy mitral valve leaflets
• Marfans syndrome

Question 11

Valve repair

Answer 11

• where suitable, valve repair usually has better long-term outcomes for patients then valve replacement

Question 12

Valve replacement with tissue valve

Answer 12

• Known as a heterograft
• Taken from pig, cow or human donors
• Don’t last as long as mechanical valves
• Long-term therapy with anticoagulant medication usually isn’t necessary

Question 13

Clinical sequelae of cardiopulmonary bypass

Answer 13

1. Haemodilution
2. Hypothermia
3. antigoagulation
4. myocardial stunning
5. atelectasis
6. pleural effusion
7. deep sternal wound infection