W9 - Cardiac Surgery Flashcards
Name the 5 types of cardiac operations
CABG
valve repair/replacement
Heart transplant
Heart lung transplant
Repair of congenital defects (neonatal, paediatric, adolescent & adults)
What does CABG stand for
Coronary artery bypass graft
What is a CABG
Surgery to treat coronary heart disease & involves bypassing a blocked portion of the coronary artery using another piece of blood vessel
Explain the procedure of a CABG
General anaesthetic
Incision made median sternotomy
Heart is stopped & kept going by a cardiopulmonary bypass or a heart lung bypass machine
Less invasive technique is key hole surgery
The blocked portion of the coronary artery is bypassed with another piece of blood vessel
One end of the graph is attached above the blockage and the other below
Takes 3-6 hours depending on the number of grafts
How do surgeons operated on a non beating heart
Using cold solution - cardioplegia
Name the 6 common graft sites used in a CABG
Saphenous vein
Radial artery
Left internal thoracic (mammary) artery
Right internal thoracic (mammary) artery
Right gastroepiploic artery
Inferior epigastric artery
Complications of a CABG
Myocardial infarction
Bleeding
Low cardiac output
Arterial fibulation
Chest infections/infections
Late graft stenosis
Vasoplegic syndrome
Pulmonary oedema/pleural effusion
Physio management for a CABG
Advise early mobility
Stair climbing 3/4 days post op
Discharged home 4/5 days post op
Rehab programme 2 weeks post op
Advice re ADL & progressive exercise
Walking 3 miles by 4/52
What physio techniques should be used post op for a CABG
Secretion clearance
Decreased WOB
increased lung volume
As & when indicated
Special considerations for a CABG
Complications can prolong ITU
High tech support may be needed which can limit physio
Don’t tolerate head down positions
Teach how to support the sternum (hear & feel clicking)
Postural correction / shoulder exercises
Mood changes / depression
Causes of valve disease
Congenital heart disease
Rheumatic fever
Cardiomyopathy
MI
Endocarditis
Aging
Symptoms of heart valve disease
SOB
ankle / feet swelling
Fatigue
How can a damaged valve affect the flow of blood
Doesn’t OPEN properly = obstructs or restricts the flow of blood causing stenosis or narrowing
Doesn’t CLOSE properly = blood leaking backwards causing leaky valve, valve incompetence or regurgitation
Name the 5 types of valance replacement surgeries
Mechanical - 15-25yrs, lifetime anticoagulants & made from pyrolytic carbon
Tissue - 10-20yrs, animal donor valves & also allied bioprosthetic
Donor - 10-20yrs, least common
Ross procedure - aortic valve is replaced with the pulmonary valve, done in children
TAVI/TAVR - trans catheter aortic valve implantation/replacement
Describe the valve replacement procedure
General anaesthetic, via the median sternotomy with or without a cardiopulmonary bypass (CPB)
Takes 2-4 hrs
Incision made in the heart
Diseased valve is removed & replaced
Once size of new valve is determined it’s stitched around the annulus and seated into place
Saline solution is flushed through the valve to check it’s working
Heart is closed up & patient is taken off the heart lung machine to restore natural function
Complications of a valve replacement
Stroke
Clotting
Valve becoming damaged
Pulmonary oedema / pleural effusion
Infection
Pneumothorax / haemothorax
Keloids
Renal impairment/failure
When is a heart transplant needed
Severe CHD
cardiomyopathy
Congenital heart disease
Where does a transplant have to come from
A heart beating donor (brain dead patient)
Transplant complications
Immune system recognises it as a foreign substance & attacks it
Donated heart fails
Narrowing of arteries supplying the heart
Side effects from immunosuppressant meds (increased vulnerability to infection, weight gain & kidney problems)
Life after a heart transplant
Regular follow ups
Immunosuppressant for life
Exercise
Diet & food hygiene awareness
Advised not to become pregnant
