Cardiothoracic Procedures Flashcards
3 cardiac surgery approaches
“open” heart surgery
davinci robotic
endovascular
open heart surgery definition
any time the chest is opened (sternotomy or thoracotomy)
davinci robotic cardiac surgery definition
more laparoscopic rather than open bc small incisions and smaller insufflation is utilized
endovascular cardiac surgery definition
possible for valve repair and types of aortic repair
is sternotomy invasive or minimally invasive?
invasive
is thoracotomy invasive or minimally invasive?
minimally invasive
is davinci invasive or minimally invasive?
minimally invasive
is endovascular repair invasive or minimally invasive?
minimally invasive
invasive
open sternotomy
provides best exposure but most complications
minimally invasive cardiac surgery (MICS)
thoracotomy, davinci, endovascular
less common but gaining popularity
3 things specific to minimally invasive cardiac surgery
called MICS
double lumen tube must be used
can be off pump or on pump with femoral vessels
two types of aorta surgery
open repair with cross clamps endovascular repair (minimally invasive)
6 surgical options for CABG
full bypass with arrested or beating heart partial bypass with beating heart off pump sternotomy thoracotomy davinci
MICS CABG
small thoracotomy incision
typically 1-2 anterior vessels
off pump or on pump with femoral vessels
davinci CABG
function to harvest the LIMA then thoracotomy is used to sew on graft
hybrid coronary revascularization
anterior vessels are bypassed using MICS/thoracotomy
posterior vessels are stented by interventional cardiologist
allows cardiac option for all vessels without sternotomy
what does the hybrid room require?
built in fluoroscopy
what procedures will happen in a hybrid room?
hybrid coronary revascularization
transcatheter aortic valve replacement (TAVR)((or TAVI))
what two types of surgeons will be in the hybrid room?
cardiac surgeon
interventional cardiologist
what is a good premedication for CABG
versed– prevent anxiety and tachycardia
CABG pts need more than valve replacement
surgical options for valve repair/replacement 6
full bypass with arrested or beating heart
right heart bypass for tricuspid or pulm valve
endovascular or transapical valve replacement (off pump)
sternotomy
thoracotomy
davinci
how do we normally repair stenotic valves?
usually replaced
how do we normally repair regurgitant valves?
repaired or replaced
repair is more likely for regurg than for stenotic
can you use versed for valve repair/replacement?
NO,
these pts need to maintain their preload and afterload