Percutaneous Revascularization Procedures Flashcards

1
Q

Percutaneous Revascularization Procedures

A
  1. Angioplasty 2. Atherectomy 3. Stenting
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2
Q

Angioplasty

A
  1. 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
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3
Q

Atherectomy

A

Cutting through the plaques and excising it using a catheter device

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4
Q

Stenting

A

Tiny mesh like scaffolds that placed into an art to increase the diameter of the lumen

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5
Q

what is the prupose of Coronary Artery Bypass Graft (CABG)

A

Provides alternate pathway for blood to transfuse the heart

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6
Q

CABG Vascular grafts

A
  • Saphenous veins, left internal
    mammary artery, radial artery
  • gastroepiploic artery (newer option)

Saph and mammary are the most common

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7
Q

Coronary Artery Bypass Graft (CABG) procedure

A
  • Median sternotomy approach
    common
  • Cardiopulmonary Bypass Machine
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8
Q

atherosclerosis

A

a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.

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9
Q

Saphenous vein Harvested Vessels

A
  • harvested for coronary bypass when numerous vessels need grafted
  • More at risk for atherosclerosis
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10
Q

Internal mammary arteries Harvested Vessels

A
  • Predominately used for the
    left coronary artery
  • More resistant to graft atherosclerosis
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11
Q

why is Cardiopulmonary Bypass Machine (CBM) used during CABG

A

During CABG (and other cardiac surgery), flow of blood through heart and lungs is interrupted

ECMO can also be used

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12
Q

Improvements and Advances in CABG

A
  • Microincisions
  • Laser revascularization
  • Off-pump coronary artery bypass (OPCAB)
  • Ultrasound-guided imaging for aorta cannulation and cross- clamping
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13
Q

Minimally invasive direct coronary artery bypass (MIDCAB) approach compared to CABG

A

3-5 inch mini-thoracotomy between ribs vs 10–12-inch median sternotomy

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14
Q

MIDCAB number of coronary arteries compared to CABG

A

indicated for bypassing one or two coronary arteries vs for three or more vessels indicated for CABG

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15
Q

MIDCAB use of bypass

A

Beating heart surgery; no bypass required (Off pump)

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16
Q

advantages of MIDCAB

A

less invasive, no sternotomy precautions, fewer complications, faster recovery, and less pain

17
Q

angiogenesis

A

the formation of new blood vessels

18
Q

Transmyocardial Laser Revascularization (TMR) done in what kind of pt

A
  • Patients who cannot undergo traditional CABG
19
Q

Transmyocardial Laser Revascularization (TMR) function

A

Procedure stimulates angiogenesis to form newer
vessels and improve blood flow

20
Q

Early Cardiac Complications after CABG

A
  • 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
21
Q

Pericarditis

A

inflammation of the pericardium

22
Q

CABG complication - bleeding

A

Some patients require a blood transfusion after CABG

23
Q

CABG complication - Neurological problems

A

stroke, neuropsychiatric abnormalities such as cognitive dysfunction, and
peripheral neuropathy

24
Q

CABG complication - Infection

A
  • Sternal wound infection and mediastinitis,1% of patients
  • Leg wound infection, cellulitis, bloodstream infection
25
CABG complication - Acute kidney injury
Results from intraoperative hypotension, postoperative cardiac complications that impair renal perfusion, hemolysis, atheroemboli, and exposure to contrast media
26
Reasons for heart valve repair or replacement
* Stenosis- valve is smaller, obstructing blood flow * Insufficiency
27
Valve Replacements most common
Aortic and mitral valve
28
Valve Replacements less common
pulmonary and tricuspid valve
29
Valve Replacements surgery precautions
Median sternotomy precautions - sternal incision
30
Two most common valve types
mechanical or bioprosthetic valve
31
mechanical valve
last a lifetime o Anti-coagulation is needed
32
bioprosthetic valve
has a limited use o 10 -20 years o Recommended for younger pt
33
Transcatheter Aortic Valve Replacement (TAVR) other name
May also be called transcatheter aortic valve implantation (TAVI)
34
Transcatheter Aortic Valve Replacement (TAVR) used when
Used to replace a narrowed aortic valve that fails to open properly
35
Transcatheter Aortic Valve Replacement (TAVR) used in what kind of pt
Used for patients at high risk for valve replacement via median sternotomy
36
Transcatheter Aortic Valve Replacement (TAVR) the valve
Delivers a fully collapsible replacement valve through the catheter
37
TAVR Advantages
* Shorter hospital stay, faster recovery, fewer precautions, and early mobility