Aortic Sx (test #2) josh's perspective

Question 1

Start with some gay facts about aortic dissections!!

1) what is the number or aortic dissections a year?
2) male/female ration of aortic dissections?
3) age of aortic dissections?

Answer 1

1) 3.5/100,000
2) 2-3/1 (male/female)
3) 75% are age 40-70 (most 50-65)

Question 2

Most aortic dissections occur at the age 75% are age 40-70 (most 50-65) unless what?

Answer 2

genetic predisposition

Question 3

Gay facts about Aortic Aneurysms!
1) what is the prevalence?
2) what is the chance of rupture in % in the following Aortic aneurysm sizes?
>5 cm
> 6cm
> 7 cm
all commers?

Answer 3

1) 3-4% in 65 and older
2)>5 cm= 20%
> 6cm= 40%
> 7 cm= 50%
all comers= 9/100,000

Question 4

more gay facts!!
Thoracic aortic aneurysm prevalence?
and rupture prevalence?

Answer 4

6/100,000

3.5/100,000

Question 5

What are the key points to aneurysm or dissection surgery (4)

Answer 5

cut out the damaged portion
replaced with dacron graft
May utilize valve conduit (if AV valve)
May spare valve

Question 6

THORACIC AORTIC SX:

What determines the approach or sx for THORACIC aneurysms or dissections of the aorta?

Answer 6

the location of it (duh dumbass)

Question 7

THORACIC AORTIC SX:

what are 3 main surgical approaches?

Answer 7

median sternotomy
Left thoracotomy
Clam shell

Question 8

THORACIC AORTIC SX:

what location is now able to be repaired endovascular?

Answer 8

descending thoracic

Question 9

THORACIC AORTIC SX:
with this sx we want to fix what will kill the pt first!! what are the 3 main things that wikl kill the pt first that we must fix (or the surgeon) per his ppt

Answer 9

coronary dissection
Severe AI
sequester the dissection
(I don’t get it but on his slides)

Question 10

THORACIC AORTIC SX:
what dictates the perfusion tech?
what tech are there (2)
what must be considered r/t sx?

Answer 10

• the extension into the arch
• femoral or traditional cannulation
• on pump or total circulatory time
• circulatory arrest

Question 11

THORACIC AORTIC SX:

circulatory arrest; what is it? and what must be done? and what will you see?

Answer 11

NO PERFUSION ANYWHERE
cool to 18 degrees C
Ice head
Steroids (perfusionist)
isoelectric EEG (barbs/etomidate/prop??)

Question 12

THORACIC AORTIC SX:

5 types of repairs? (just give me the names?)

Answer 12

bentall
Cabrol
Florida Sleeve
Elephant trunk
thoraco-abdominal

Question 13

DESCENDING THORACIC AORTIC SX:
in the past is whs repaired how?
Currently it’s repaired with what?

Answer 13

• -old— staged repair

- Now- sent graft

Question 14

THORACIC AORTIC SX ANESTHETIC IMPLICATIONS:

How to treat preop HTN

Answer 14

SNP
nicardipine
esmolol

Question 15

THORACIC AORTIC SX ANESTHETIC IMPLICATIONS:

what 3 things must you anticipate in these surgeries?

Answer 15

Cardiopulmonary bypass +/- circ arrest
Large blood loss
Failure to wean

Question 16

THORACIC AORTIC SX ANESTHETIC IMPLICATIONS:

why is there a high chance of failure to wean in these pt’s?

Answer 16

-systolic dysfunction r/t long CPB time or circ time

maybe try an IABP????

Question 17

THORACIC AORTIC SX ANESTHETIC IMPLICATIONS:

what 3 things should you do to these pt’s?

Answer 17

large bore central access
cell saver in room
invasive monitoring

Question 18

THORACIC AORTIC SX ANESTHETIC IMPLICATIONS:

what are some invasive monitors to use?

Answer 18

A-line
PA cath (+/-)
TEE