Surgery : Cardiac Surgery Flashcards
Indications for CABG
CAD that is refractory to med treatments Unstable angina Chronic Angina Symptomatic/Complicated MI Triple Vessel Disease Diabetes with 2 Vessel Disease
Gold standard for diagnosing extent of CAD and latency of vessels ?
PCI Angiography (allows for simultaneous treatment by placing a stent )
What are the two main type of grafts used in CABG
Saphenous Vein
Internal Mammary Artery (thoracic)
Saphenous vein grafts typically are used to connect which two structures ?
Aorta and Right Coronary Artery
Internal Mammary Artery grafts connect which two structures ?
Subclavian (via root of IMA) and the Left Anterior Descending Artery (Left Internal Mammary artery is used )
Patency rate of Saphenous grafts at 10 yrs
50% occlusion at 10 years
Patency rate of LIMA grafts at 10 yrs
95%
When patient has good LV function, No comorbidities and is less than 80%, what is the mortality rate for CABG graft with these patients ?
1-2%
Risk factors for morbidity and mortality related to CABG graft surgery
Age (>80) COPD PVD Previous open heart surgery Renal Insufficiency (if kidneys were shot beforehand, not really going to make a difference ) LV dysfunction Recent MI < 90 days
How long after surgery until the patient will be up and walking ?
first 24 hrs !
ICU admission x at least 24 hours Intubated Chest tube Pacemaker electrodes Average total LOS 5 days Out of bed and walking post op day one Discharge home ASAP
Traditional CABG
Sternotomy incision
Heart is STOPPED
Bypass machine with blood HEPARINIZED
Still the most common procedure
Off Pump CABG
Sternotomy incision Performed on a beating heart No bypass machine, no heparin required Better results , fewer complications Takes longer, not appropriate for complex procedures Not yet universally available
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Small left side incision
Performed on beating heart
No bypass machine, no heparin
Limited to anterior surface of the heart – LIMA to LAD**
Takes longer, not appropriate for complex procedures
Not yet universally available
Total endoscopic coronary artery bypass
Still in development Endoscopic instruments through tiny incisions Requires robotic equipment Beating or non beating heart You know the rest
Prevalence of Atrial Fib. post CABG and Valve replacement respectively ?
25% 50% Even when treated with Beta Blockers Continue to treat with BB or CCB's If A Fib goes on for 48 Hrs then anti-coagulate. (most resolve within 24 hrs)
