STS E Book - Coronary Artery Bypass Grafting Flashcards

1
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for asymptomatic patients?

A

Left main stenosis, left main equivalent (proximal LAD and circumflex), 3v dz, 2v dz including prox LAD + LV dysfx.

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2
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for symptomatic patients with non-STEMI?

A

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.

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3
Q

2014 ACC/AHA/AATS/SCAI/STS guidelines for CABG indications for STEMI?

A
  • 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.
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4
Q

In general, patients with coronary artery disease, good ventricular function, minimal symptoms, and limited myocardium at risk should be initially be treated with what?

A

Best medical management.

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5
Q

In general, patients with CAD who have symptoms that compromise quality of life should be treated with what?

A

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.

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6
Q

What is fibrillatory arrest with CPB?

A

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.

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7
Q

What are advantages of cardiac arrest w/ CPB?

A

Bloodless field, flaccid heart, diastolic arrest, well protected. Myocardial protection is the key component - del Nido solution.

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8
Q

How long is del Nido effective for aortic cross-clamping?

A

90 minutes.

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9
Q

What is the typical pattern of multi-vessel anastomosis in CABG w/ cardiac arrest?

A

Less important, but typically distal to back of the heart (RC system), lateral wall (circ), LAD, then proximal anastomoses.

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