Percutaneous Revascularization Procedures

Question 1

Percutaneous Revascularization Procedures

Answer 1

1. Angioplasty 2. Atherectomy 3. Stenting

Question 2

Angioplasty

Answer 2

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

Question 3

Atherectomy

Answer 3

Cutting through the plaques and excising it using a catheter device

Question 4

Stenting

Answer 4

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

Question 5

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

Answer 5

Provides alternate pathway for blood to transfuse the heart

Question 6

CABG Vascular grafts

Answer 6

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

Saph and mammary are the most common

Question 7

Coronary Artery Bypass Graft (CABG) procedure

Answer 7

• Median sternotomy approach
  common
• Cardiopulmonary Bypass Machine

Question 8

atherosclerosis

Answer 8

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

Question 9

Saphenous vein Harvested Vessels

Answer 9

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

Question 10

Internal mammary arteries Harvested Vessels

Answer 10

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

Question 11

why is Cardiopulmonary Bypass Machine (CBM) used during CABG

Answer 11

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

ECMO can also be used

Question 12

Improvements and Advances in CABG

Answer 12

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

Question 13

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

Answer 13

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

Question 14

MIDCAB number of coronary arteries compared to CABG

Answer 14

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

Question 15

MIDCAB use of bypass

Answer 15

Beating heart surgery; no bypass required (Off pump)

Question 16

advantages of MIDCAB

Answer 16

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

Question 17

angiogenesis

Answer 17

the formation of new blood vessels

Question 18

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

Answer 18

• Patients who cannot undergo traditional CABG

Question 19

Transmyocardial Laser Revascularization (TMR) function

Answer 19

Procedure stimulates angiogenesis to form newer
vessels and improve blood flow

Question 20

Early Cardiac Complications after CABG

Answer 20

• 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

Question 21

Pericarditis

Answer 21

inflammation of the pericardium

Question 22

CABG complication - bleeding

Answer 22

Some patients require a blood transfusion after CABG

Question 23

CABG complication - Neurological problems

Answer 23

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

Question 24

CABG complication - Infection

Answer 24

• Sternal wound infection and mediastinitis,1% of patients
• Leg wound infection, cellulitis, bloodstream infection

Question 25

CABG complication - Acute kidney injury

Answer 25

Results from intraoperative hypotension, postoperative cardiac complications that impair renal perfusion, hemolysis, atheroemboli, and exposure to contrast media

Question 26

Reasons for heart valve repair or replacement

Answer 26

• Stenosis- valve is smaller, obstructing blood flow
• Insufficiency

Question 27

Valve Replacements most common

Answer 27

Aortic and mitral valve

Question 28

Valve Replacements less common

Answer 28

pulmonary and tricuspid valve

Question 29

Valve Replacements surgery precautions

Answer 29

Median sternotomy precautions
- sternal incision

Question 30

Two most common valve types

Answer 30

mechanical or bioprosthetic valve

Question 31

mechanical valve

Answer 31

last a lifetime
o Anti-coagulation is needed

Question 32

bioprosthetic valve

Answer 32

has a limited use
o 10 -20 years
o Recommended for younger pt

Question 33

Transcatheter Aortic Valve Replacement (TAVR) other name

Answer 33

May also be called transcatheter aortic valve implantation (TAVI)

Question 34

Transcatheter Aortic Valve Replacement (TAVR) used when

Answer 34

Used to replace a narrowed aortic valve that fails to open properly

Question 35

Transcatheter Aortic Valve Replacement (TAVR) used in what kind of pt

Answer 35

Used for patients at high risk for valve replacement via median sternotomy

Question 36

Transcatheter Aortic Valve Replacement (TAVR) the valve

Answer 36

Delivers a fully collapsible replacement valve through the catheter

Question 37

TAVR Advantages

Answer 37

• Shorter hospital stay, faster recovery, fewer precautions, and early mobility