Ischaemic Heart Disease: Revascularisation

Question 1

Surgical technique of coronary artery bypass?

Answer 1

Median sternotomy

Different grafts can be used, e.g: long saphenous vein, internal mammary artery

A cardio-pulmonary bypass is required - temp takes over heart and lung function during surgery

Cardiplegia - temp and intentional cessation of cardiac activity

Question 2

Risks with surgery?

Answer 2

Risk of graft disease, 8-10 years post-op

Question 3

Complications of CABG?

Answer 3

Death
Stroke
MI
AF - 2/3rd of patients will have this after CABG
Infection
Cognitive impairment
Sternal malunion
Renal failure

Question 4

What is PCI?

Answer 4

Percutaneous Coronary Intervention - i.e: coronary angioplasty

Question 5

Complications of PCI?

Answer 5

Death
Stroke
Contrast nephropathy
MI
Renal failure
Bleeding
Vascular complications
Stent thrombosis
Stent restenosis

Also, stent failure

Question 6

PCI technique?

Answer 6

Requires vascular access for a catheter to go into ostium of coronary

Guidewire down a vessel, with balloons threaded over the wire

Stent(s) implanted

Balloon, catheter and wires are removed

Anti-platelets and anti-coagulants required

Question 7

Indications for an angiography?

Answer 7

Severe symptoms

High risk patient

Question 8

Determining suitability for revascularisation?

Answer 8

If they have:
Multi-vessel disease, diffuse or focal
Left main disease
Diabetes
Co-morbidites

Question 9

Radial artery access?

Answer 9

Dual supply to hand that is superficial and compressible; also, there is no adjacent nerve/vein

But it is smaller, prone to spasm and there can be asymptomatic occlusion (in 5%)

Question 10

Summary?

Answer 10

STEMI: Primary PCI

Acute coronary syndrome: angiography with a view to revascularisation

Chronic stable angina: Revascularisation for severe symptoms or high risk - CABG vs PCI should be determined by discussion