Cardio Surgery

Question 1

What are 6 indications for heart surgery?

Answer 1

1. Refractory CAD
2. Unstable angina
3. Chronic Angina
4. Myocardial infarction w/ symptoms
5. Triple vessel disease
6. Diabetes and 2 or 3 vessel disease

Question 2

Gold standard for mapping coronary vasculature before surgery.

Answer 2

Catheter angiography

Question 3

Name the two types of Coronary Artery Bypass Grafts and when they are used.

Answer 3

1. Saphenous Vein: occlusion of 50% at 10 years, used best for Right Coronary Artery
2. Internal Mammary: occlusion of 5% at 10 years, best used for LAD bypass

Question 4

What is the time frame for a good prognosis for CABG after a patient has had an MI?

Answer 4

Better prognosis at least 90 days after MI

Question 5

What are advantages and disadvantages of “Off Pump CABG”?

Answer 5

Ad: no need for heparin, better results with fewer complications

Dis: not for complicated surgeries.

Question 6

What is protocol for an atrial fibrillation complication after surgery?

Answer 6

Monitor for 48 hrs (80% resolve)

-anticoagulation if prolonged beyond 2 days

Question 7

When is the best time to replace an aortic valve?

Answer 7

Just before the symptoms start.

• area less than 0.5mm (in stenosis)
• angina, syncope, HF symptoms

Question 8

Name the two types of valve replacement and when to use each.

Answer 8

Mechanical: lasts long time, but need anticoagulants
-best for young pts, A. fib pts

Bioprosthetic: no anticoagulants, but doesn’t last as long
-best for elderly, pregnant pts