Percutaneous Revascularization Procedures Flashcards
Percutaneous Revascularization Procedures
- Angioplasty 2. Atherectomy 3. Stenting
Angioplasty
- When the lumen of a coronary art is partially or completely block by a plaques
a. A balloon tipped catered is inserted
b. The balloon is inflated to compress the lesion against the wall of the art
Atherectomy
Cutting through the plaques and excising it using a catheter device
Stenting
Tiny mesh like scaffolds that placed into an art to increase the diameter of the lumen
what is the prupose of Coronary Artery Bypass Graft (CABG)
Provides alternate pathway for blood to transfuse the heart
CABG Vascular grafts
- Saphenous veins, left internal
mammary artery, radial artery - gastroepiploic artery (newer option)
Saph and mammary are the most common
Coronary Artery Bypass Graft (CABG) procedure
- Median sternotomy approach
common - Cardiopulmonary Bypass Machine
atherosclerosis
a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.
Saphenous vein Harvested Vessels
- harvested for coronary bypass when numerous vessels need grafted
- More at risk for atherosclerosis
Internal mammary arteries Harvested Vessels
- Predominately used for the
left coronary artery - More resistant to graft atherosclerosis
why is Cardiopulmonary Bypass Machine (CBM) used during CABG
During CABG (and other cardiac surgery), flow of blood through heart and lungs is interrupted
ECMO can also be used
Improvements and Advances in CABG
- Microincisions
- Laser revascularization
- Off-pump coronary artery bypass (OPCAB)
- Ultrasound-guided imaging for aorta cannulation and cross- clamping
Minimally invasive direct coronary artery bypass (MIDCAB) approach compared to CABG
3-5 inch mini-thoracotomy between ribs vs 10–12-inch median sternotomy
MIDCAB number of coronary arteries compared to CABG
indicated for bypassing one or two coronary arteries vs for three or more vessels indicated for CABG
MIDCAB use of bypass
Beating heart surgery; no bypass required (Off pump)
advantages of MIDCAB
less invasive, no sternotomy precautions, fewer complications, faster recovery, and less pain
angiogenesis
the formation of new blood vessels
Transmyocardial Laser Revascularization (TMR) done in what kind of pt
- Patients who cannot undergo traditional CABG
Transmyocardial Laser Revascularization (TMR) function
Procedure stimulates angiogenesis to form newer
vessels and improve blood flow
Early Cardiac Complications after CABG
- Myocardial infarction (MI)
- Graft occlusion (with or without MI)
- Low cardiac output due to ventricular dysfunction
- Vasodilatory shock-
- marked reduction in systemic vascular resistance with a well
preserved or increased cardiac output - Atrial and ventricular arrhythmias
- Pericarditis
Pericarditis
inflammation of the pericardium
CABG complication - bleeding
Some patients require a blood transfusion after CABG
CABG complication - Neurological problems
stroke, neuropsychiatric abnormalities such as cognitive dysfunction, and
peripheral neuropathy
CABG complication - Infection
- Sternal wound infection and mediastinitis,1% of patients
- Leg wound infection, cellulitis, bloodstream infection
CABG complication - Acute kidney injury
Results from intraoperative hypotension, postoperative cardiac complications that impair renal perfusion, hemolysis, atheroemboli, and exposure to contrast media
Reasons for heart valve repair or replacement
- Stenosis- valve is smaller, obstructing blood flow
- Insufficiency
Valve Replacements most common
Aortic and mitral valve
Valve Replacements less common
pulmonary and tricuspid valve
Valve Replacements surgery precautions
Median sternotomy precautions
- sternal incision
Two most common valve types
mechanical or bioprosthetic valve
mechanical valve
last a lifetime
o Anti-coagulation is needed
bioprosthetic valve
has a limited use
o 10 -20 years
o Recommended for younger pt
Transcatheter Aortic Valve Replacement (TAVR) other name
May also be called transcatheter aortic valve implantation (TAVI)
Transcatheter Aortic Valve Replacement (TAVR) used when
Used to replace a narrowed aortic valve that fails to open properly
Transcatheter Aortic Valve Replacement (TAVR) used in what kind of pt
Used for patients at high risk for valve replacement via median sternotomy
Transcatheter Aortic Valve Replacement (TAVR) the valve
Delivers a fully collapsible replacement valve through the catheter
TAVR Advantages
- Shorter hospital stay, faster recovery, fewer precautions, and early mobility
