Cardiac Surgery (2)

Question 1

What is Percutaneous coronary intervention?

Answer 1

Non surgical provide her that uses a catheter and balloon to place a stent to open a vessel

Question 2

What are the two types of stents used in Percutaneous coronary intervention?

Answer 2

Bare metal stents

Drug eluting stents (more commonly used today)

Question 3

What is an endarterectomy?

Answer 3

Surgical removal of part of the inner lining of the artery or any obstructive deposits

Question 4

Where is an endarterectomy most commonly performed?

Answer 4

Carotid and femoral arteries

Question 5

What is a temporary epicardial pacer?

Answer 5

Pacer to control heart rate and rhythm because myocardium is prone to arrhythmia post open heart surgery

Question 6

What is the most common restriction when getting a pacemaker?

Answer 6

Limited L UE motion and exertion 1-2 weeks

Question 7

What is the safety margin that patients should maintain when getting a pacemaker?

Answer 7

10% between exercise HR and rate cutoff for device

Question 8

What are implantable cardioverter defibrillators useful for?

Answer 8

Preventing sudden death in patients with known ventricular tachycardia or fibrillation

Question 9

What does an implantable cardioverter defibrillator do?

Answer 9

Tracks HR and rhythm and applies a shock to absolve any arrhythmias

Question 10

What surgeries use a median sternotomy?

Answer 10

CABG

Valve replacement or repair

Heart transplant

Question 11

What is a thoractomy used for?

Answer 11

Lobectomy

Question 12

What is a bilateral thoracotomy (clamshell) used for?

Answer 12

Lung transplant

Question 13

What is a minimally invasive cardiac surgery used for?

Answer 13

CABG

Valve surgery

Question 14

What is a video assisted thoracic surgery used for?

Answer 14

Lobectomy (lung cancer)

Question 15

What are the common vessels used for a CABG?

Answer 15

Saphenous vein

Left internal mammary artery

Question 16

Why are left internal mammary arteries becoming more used than saphenous artery for CABG?

Answer 16

Remains open longer (90% in 10 years)

Saphenous still used for emergency CABG due to easier access

Question 17

What are the disadvantages of using a left internal mammary artery for a CABG?

Answer 17

Limited length of vessel

May prolong surgery

Risk of Sternal wound failure

Question 18

How long does a CABG surgery take to complete?

Answer 18

About 4 hours

Question 19

How is the body supported during a CABG?

Answer 19

By a cardiopulmonary bypass for about 90 minutes

Question 20

How often can someone get out of the ICU after a CABG?

Answer 20

The day after surgery

Question 21

What are complications post CABG?

Answer 21

Temporary atrial fibrillation due to surgical trauma to heart (most resolves one month after surgery)

Question 22

What type of valves are used for a valve replacement surgery?

Answer 22

Mechanical

Biological made of human (cadaver) or pig tissue (xenograft)

Question 23

What’s the risk of getting a mechanical valve replacement?

Answer 23

Requires anti-coagulant meds for thrombus risk and has higher risk of infection

Question 24

Who is a trans-catheter valve repair used in?

Answer 24

Patients at high risk for open heart surgery (older patients)

Question 25

What is important to make sure you get your patient before they leave post cardiac surgery?

Answer 25

Referral for cardiac rehab

Question 26

What is discharge time for a stent/PCI?

Answer 26

1-2 days

Question 27

What is discharge time for CABG?

Answer 27

4-5 days

Question 28

What is discharge time for valve replacement?

Answer 28

2-3 days

Question 29

What are Sternal precautions post surgery?

Answer 29

No shoulder flexion or abduction > 90°

Lifting restrictions 8-10 lbs for 6 weeks, then 30 lbs for 3 months

No push/pull

Splint chest while coughing

Avoid Valsalva

Question 30

What is a new precaution that is making it better for patients post cardiac surgery?

Answer 30

Keep your move in the tube