Cardiac Surgery Flashcards
Types of cardiac operations -
CABG
Valve repair/ replacement
Heart transplant
Heart lung transplant
Repair of congenital heart defects - neonatal, paediatric, adolescent and adult
What is a CABG?
Coronary artery bypass graft
A surgical procedure used to treat coronary heart disease
Involves bypassing a blocked portion of a coronary artery using another piece of blood vessel
Can be single or multiple arteries
CABG procedure -
Incision made via a median sternotomy
Traditionally the heart is stopped during surgery and kept going via a cardiopulmonary bypass (CPB) or heart lung bypass machine
Less invasive techniques have been adapted such as key hole
Cold solution - cardioplegia allows cardiac arrest so surgeon can operate on non beating heart
The blocked portion of the coronary artery is bypassed with another piece of blood vessel
On end of graft is attached above the blockage and the other below blockage, thus bypassing it to reach the myocardial tissue
Takes generally 3-6 hours depending on how many grafts are needed
CABG - common graft sites =
Saphenous vein
Radial artery
Left internal thoracic (mammary) artery (LITA)
Right internal thoracic (mammary) artery (RITA)
Right gastroepiploic artery
Inferior epigastric artery
Complications of a CABG -
Perioperative MI
Bleeding
Low cardiac output
AF
Lower lobe collapse
Restrictive lung deficit
Chest infection/pnuemonia
Other infection
Late graft stenosis
Non union of sternum
Pericardial tamponade
Pulmonary oedema/pleural effusion
Pneumothorax
Wound infection
Grafts only last 8-15 years
Chronic pain at incision sits
Keloid scarring
Physio management of CABG -
Advice regarding early mobilisation
- stair climbing day 3/4 postop
- discharge home 4/5 days postop
- rehab programme 2 weeks post surgery
- advice re ADL and progressive exercise
Should be walking approx 3 miles in 4/52
Physios can also adopt techniques such as:
Secretion clearance
Decrease WOB
Increased lung volume
CABG - special considerations -
Complications may lead to prolonged ITU stay
May require ‘high tech’ support which can limit physio treatments
Do not tolerate head down positions
Teach how to support sternum - if problem with sternum may hear or feel clicking
May need postural correction
Mood change/depression common in postoperative recovery period
Heart valve disease
Types of valve replacement, mechanical -
Tissue -
Mechanical - long lasting 15-25 years
Require long term anticoagulants
Made of pyrolytic carbon
Tissue - sometimes called ‘bioprosthetic’
Created from animal donors valves or other animal tissue
Last 10-20 years
Heart valve disease
Types of valves replacement -
Donor -
Ross procedure -
TAVI/TAVR -
Donor - least common
Last 10-20 years
Ross procedure - aortic valve is replaced with the pulmonary valve, which is subsequently replaced as well
TAVI/R - transcatheter aortic valve implantation or replacement
Valve replacement procedure -
Similar approach to a CABG of under GA, normally via a median sternotomy with or without the use of CPB
Takes 2-4 hours depending on number of valves
Incision to the heart is made, allowing surgeon to see the valve
Diseased valve is then removed and the size of the new valve is determined
Once size has been determined, valve is stitched to around the annulus and seated into place
Saline is then flushed through the valve to check is competency
Heart is closed up and patient taken off heart lung machine to restore natural function
Complications to valve replacements -
Stroke, clotting, arrhythmias
Valves become damaged/worn out
Chest infection/pneumonia
Other infection
Pulmonary oedema/pleural effusions
Pneumothorax
Renal impairment/failure
Wound infection
Chronic pain at incision sites
Keloid scarring
Pericardial tamponade
Non union of sternum
Transplantation - requirements and when needed -
Has to be from a heart beating donor
Needed:
In severe CHD
Cardiomyopathy
Congenital heart disease
Complications of transplantations -
Immune system recognising the transplanted organ as foreign and attacking it (rejection)
Donated heart failing to work properly
Narrowing of the arteries suppling the heart (cardiac allograft vasculopathy)
Side effects from the immunosuppressant medication such as increased vulnerability to infections, weight gain and kidney problems
Plus the previous stated complications on CABg and valve surgery
Transplantation life expectancy -
80 to 90 in every 100 people will live at least a year
70 to 75 in every 100 people will live at least 5 years
50 in every 100 will live at least 10 years
Someone people have survived for more than 25 years after a heart transplant
Transplantation, life after -
Regular follow up appointments
Immunosuppressants for life
Exercise
Diet
Pregnancy
