Cardiac surgery Flashcards
cardiac operations
CABG, valve repair/ replacement, heart transplant, repair of congenital heart defects- neonatal, paediatric, adolescent and adults
what is CABG surgery
a surgical procedure used to treat coronary heart disease. involves by passing a blocked portion of a coronary artery using another piece of blood vessel. can be single or multiple. takes generally 3-6 hours depending on how many grafts are needed. grafts last 8-15 years
CABG- procedure
General anesthetic, incision via median sternotomy. traditionally the heart is stopped during surgery and kept going via a cardiopulmonary bypass. less invasive techniques have been developing such as keyhole surgery. cold solution- cardioplegia allow cardiac arrest so surgeon can operate in non-beating bloodless heart. one end of the graft is attached above the blockage and the other below the blockage, thus bypassing it to reach the myocardial tissue.
common graft sites
saphenous vein, radial artery, left internal thoracic, right internal thoracic artery, right gastroepiploic artery, inferior epigastric artery
CABG- ITA or IMA
internal thoracic artery, internal mammary artery, not harvested used in position they are in, as long as there is enough arteries in this area
CABG- GEA
gastroepiploic artery, mobilised of stomach taken to post coronary artery
complications of CABG surgery
perioperative MI, bleeding (2-5% require reopening), low CO, atrial fibrillation (40% of patients), lower lobe collapse, restrictive lung defect, chest infection/ pneumonia, other infection, late graft stenosis, non-union of sternum, pulmonary oedema/ pleural effusion, pneumothorax/ haemothorax, renal failure, wound infection, neurological- CVA (1-5%), chronic pain at incision site, keloid scarring
CABG- physio management
uncomplicated cardiac surgery, techniques used- secretion clearance, decrease WOB, increase lung volume, as and when indicated. advice regarding early mobilisation- 1 day= sit on edge of bed/ stand at end of bed, 2= stand away from bed, 3/4 stair climbing day, 4/5 discharge home post op- depends on pre op fitness and complication. rehab 2 weeks post surgery, advice on ADL
special consideration
complications may lead to prolonged ITU stay- same treatment as any ITU patient. may require high tech support- limit physio treatment. do not tolerate head down position. teach how to support sternum- if problem with hearing may feel or hear cracking. may need postural correction. mood change/ depression common post op
types of valve replacement- mechanical
long lasting 15-25 years. require long term anticoagulants. made of pyrolytic carbon.
types of valve replacement- tissue and donor
tissue (AKA bioprosthetic)- created from animal donors valves or other animal tissue, last 10-20 years
donor- least common, 10-20 years
types of valve replacement- ross procedure or TAVI/TAVR
the aortic valve is replaced with pulmonary valve, which is subsequently replace as well. less need for long term medication. TAVI/TAVR- transcatheter aortic valve implantation or replacement- takes over function of valve
valve replacement- procedure
similar approach to CABG under GA, incision made via a median sternotomy with or without the use of CPB. takes 2-4 hours (depends on number of valves). incision made- surgeon can see valve, the disease valve is removed size of new valve determine- the seated into place. Saline is then flushed through the valve to check competency. the heart is then closed up and patient is then taken off the heart lung machine to restore natural function.
valve replacement- complication
stroke, clotting, arrhythmia, valves become damaged/worn, chest infection/ pneumonia, other infection, pulmonary oedema/pleural effusion, pneumothorax/ haemothorax, renal failure, wound infection, chronic pain at incision site, keloid scarring, pericardial tamponade, non-union of sternum
post op valve replacement
follows same post op as CABG
