Surgery : Cardiac Surgery Flashcards Preview

Cardiology Exam IV > Surgery : Cardiac Surgery > Flashcards

Flashcards in Surgery : Cardiac Surgery Deck (27):
1

Indications for CABG

CAD that is refractory to med treatments
Unstable angina
Chronic Angina
Symptomatic/Complicated MI
Triple Vessel Disease
Diabetes with 2 Vessel Disease

2

Gold standard for diagnosing extent of CAD and latency of vessels ?

PCI Angiography (allows for simultaneous treatment by placing a stent )

3

What are the two main type of grafts used in CABG

Saphenous Vein
Internal Mammary Artery (thoracic)

4

Saphenous vein grafts typically are used to connect which two structures ?

Aorta and Right Coronary Artery

5

Internal Mammary Artery grafts connect which two structures ?

Subclavian (via root of IMA) and the Left Anterior Descending Artery (Left Internal Mammary artery is used )

6

Patency rate of Saphenous grafts at 10 yrs

50% occlusion at 10 years

7

Patency rate of LIMA grafts at 10 yrs

95%

8

When patient has good LV function, No comorbidities and is less than 80%, what is the mortality rate for CABG graft with these patients ?

1-2%

9

Risk factors for morbidity and mortality related to CABG graft surgery

Age (>80)
COPD
PVD
Previous open heart surgery
Renal Insufficiency (if kidneys were shot beforehand, not really going to make a difference )
LV dysfunction
Recent MI < 90 days

10

How long after surgery until the patient will be up and walking ?

first 24 hrs !


ICU admission x at least 24 hours
Intubated
Chest tube
Pacemaker electrodes
Average total LOS 5 days
Out of bed and walking post op day one
Discharge home ASAP

11

Traditional CABG

Sternotomy incision
Heart is STOPPED
Bypass machine with blood HEPARINIZED
Still the most common procedure

12

Off Pump CABG

Sternotomy incision
Performed on a beating heart
No bypass machine, no heparin required
Better results , fewer complications
Takes longer, not appropriate for complex procedures
Not yet universally available

13

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

Small left side incision
Performed on beating heart
No bypass machine, no heparin
Limited to anterior surface of the heart – LIMA to LAD****
Takes longer, not appropriate for complex procedures
Not yet universally available

14

Total endoscopic coronary artery bypass

Still in development
Endoscopic instruments through tiny incisions
Requires robotic equipment
Beating or non beating heart
You know the rest

15

Prevalence of Atrial Fib. post CABG and Valve replacement respectively ?

25%
50%
Even when treated with Beta Blockers
Continue to treat with BB or CCB's
If A Fib goes on for 48 Hrs then anti-coagulate. (most resolve within 24 hrs)

16

RIsk factors for post op A.fib ?

Age
HTN
Increased time on Ventilation

17

Valve Replacement due to Aortic Stenosis: What 4 classes of Aortic stenosis are there ?

Congenital
Calcific (age related)
Endocarditis
Rheumatic

18

Symptoms associated with Stenotic Aoritic Valve

CHF
Syncope
Angina
Critical valve area .5cm2

19

Causes of Aortic Vavle Regurgitation

Rheumatic
Endocarditis
Aortic root disease --> dilation
Seen in Marfans and Syphilis.

20

Mechanical Aortic Valves

St. Jude is most common
Last very long time
Patient must be anticoagulated for rest of life

Contraindicated in cerebral and GI bleeds due to need for anti-coagulation

21

Bioprosthetic Aortic Valves

Porcine
Bovine
Cadaveric Homograft

Last 10-15 yrs
Do not require anti-coagulation

22

What Valve: Young healthy patient ?

Mechanical

23

What Valve: Elderly with multiple health problems

BP since it will last 10 years and will not need anti-coagulation

24

What Valve: Woman of child bearing years

Bioprosthetic since we cannot anti-coagulate this patients properly

25

What Valve: Patient With A-fib

Mechanical, will need to be anti-coagulated anyhow

26

Treatment of Mitral Vavle Stenosis

Percutaneous balloon valvuloplasty
Open mitral commissurotomy
Mitral valve replacement
Esp. if pulm. HTN***

27

Multi-valve disease

Aortic + Mitral
Mitral + Tricuspid
Triple valve disease
Excellent results in elderly and high risk patients
Valve replacement is very rarely denied unless the only option is transplant