STS E Book - Coronary Artery Bypass Grafting Flashcards
2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for asymptomatic patients?
Left main stenosis, left main equivalent (proximal LAD and circumflex), 3v dz, 2v dz including prox LAD + LV dysfx.
2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for symptomatic patients with non-STEMI?
2-vessel disease not involving LAD if large area of myocardium involved.
Single-vessel disease if LAD if associated with extensive ischemia and LV dysfunction.
Should be done before DC.
2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for STEMI?
- Failed angioplasty w/ persistent pain or hemodynamic instability.
- Persistent uncontrollable angina w/ acceptable vessels and large amount of myocardium at risk.
- Mechanical complications of STEMI (LV rupture, VSD, and/or acute valve insufficiency).
- Cardiogenic shock w/ myocardium at risk.
- Recurrent or life-threatening arrhythmias w/ left main or triple vessel disease.
In general, patients with coronary artery disease, good ventricular function, minimal symptoms, and limited myocardium at risk should be initially be treated with what?
Best medical management.
In general, patients with CAD who have symptoms that compromise quality of life should be treated with what?
Revascularization (should be considered). CABG appears to be lower risk of mortality compared to PCI in most patients w/ DM and complex multi-vessel disease.
What is fibrillatory arrest with CPB?
Similar to on-pump beating heart surgery, but induced V fib provides non-beating operative field. Induced w/ T <30C or metal clips attached to AC current. LV sump/vent required to prevent LV distention. Distal anastomosis before proximal if heart beating. Distal anastomosis can be done under fibrillatory, but cooling is required to protect the heart, especially w/ LV hypertrophy.
What are advantages of cardiac arrest w/ CPB?
Bloodless field, flaccid heart, diastolic arrest, well protected. Myocardial protection is the key component - del Nido solution.
How long is del Nido effective for aortic cross-clamping?
90 minutes.
What is the typical pattern of multi-vessel anastomosis in CABG w/ cardiac arrest?
Less important, but typically distal to back of the heart (RC system), lateral wall (circ), LAD, then proximal anastomoses.