Cardiac Surgeries

Question 1

Coronary Artery Bypass Graft - Definition

Answer 1

> Surgery for Coronary Heart Disease

> Blocked portion of coronary artery is bypassed using another piece of blood vessel

Question 2

CABG - Procedure

Answer 2

> Median Sternotomy
General Anaesthetic
Heart = stopped by cold solution (cardioplegia)
Cardiopulmonary bypass machine does job of heart during surgery

Question 3

CABG - Complications

Answer 3

> Bleeding 
> Low Cardiac Output 
> Myocardial Infarction
> Atrial Fibrillation
> Pericardial Tamponade (blood collects + compresses heart)
> Restrictive Lung deficit 
> Pulmonary oedema
> Pneumothorax
> CVA 
> Infection
> Renal failure 
> Chronic Pain

Question 4

CABG - Graft sites

Answer 4

> Saphenous vein
Radial Artery

*used in situ
> Left/Right internal thoracic artery
> Right gastroepiplotic artery

Question 5

CABG - Physio

Answer 5

> Uncomplicated Surgery
- Secretion clearance
- Decrease WoB 
- Increase Lung Volume
\+ early mobilisation 
\+ advice/ education 

> Complicated Surgery

• High tech support might limit physio
• NO HEAD DOWN positions
• Sternum support
• Postural Correction
• Shoulder exercises
• Mood changes + depression = common

Question 6

Valve Replacement Surgery (valves)

Answer 6

> Mechanical (Pyrolytic Carbon)

• lasts ~ 15-25 years
• Requires long term anticoagulants

> Tissue (Animal - ‘bioprosthetic’)
- lasts ~ 10-20 years

> Donor (human - least common)
- lasts ~ 10-20 years

> Ross Procedure (mainly in children as valves have time to adapt)

• Aortic valve is replaced by pulmonary valve
• pulmonary valve is then replaced by prosthetic

> Transcatheter Aortic valve implementation
- New valve is placed inside old one

Question 7

Valve Replacement - Procedure

Answer 7

> GA
Median Sternotomy
- possibly with cardiopulmonary bypass machine
Heart incision
Saline solution flushed through to check that new valve works

Question 8

Valve Replacement - Complications

Answer 8

> Thrombus (embolus risk)
> Arrythmia 
> Infection 
> Valve damage 
> Pericardial Tamponade 
> Pulmonary Oedema 
> Pneumothorax

Question 9

Heart Transplant

Answer 9

> Requires living donor

Indications
> Severe CHD
> Cardiomyopathy
> Congenital Heart Disease

> Complications 
- Rejection 
- Graft failure 
- Narrowing of arteries
- Immunosuppressants - side effects 
\+ Surgical complications 

> Prognosis

• 50 % survival past 10 yrs
• Regular follow ups + immunosuppressants needed