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17 Cards in this Set

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Indications for CABG
- Refractory to medical therapy
- Triple vessel disease (especially with LV dysfunction)
- > 50% left main occlusion
- Two vessel disease with >75% proximal LAD
- Diabetes + 2 or 3 vessel disease
2 types of grafts in CABG
Saphenous vein

Internal mammary artery - branch of subclavian
Patency rate for saphenous vein graft
50% in 10 years
Patency rate for IMA graft
90% in 10 years
Where do you put saphenous vein graft
RCA

LCX
Where do you put internal mammary artery graft
LAD
Operative mortality rate for CABG is 1-2% when patient has _
No comorbidities

Good LV function

Age< 80
Risk factors for morbidity and mortality
Age

Renal insufficiency

PVD

COPD

Prior open heart surgery

LV dysfunction

Recent MI
Very common despite beta-blocker prophylaxis
25% post CABG
50 % post valve replacement
Post op atrial fibrillation
What are the risk factors of post op a fib
Increased age

HTN

Ventillator

IABP
Treatment of post op AF, prognosis?
Esmolol, metoprolol
Verapamil, diltiazem
- 80% revert to regular sinus rhythm w/in 24 hrs
Treatment if post op AF lasts more than 48 hours
Anticoagulation
Minimally invasive CABG vs regular CABG
-Heart still beating
-Less post op bleeding, DVT, PE, renal insuff.
-Less post op pain, wound infection
Causes of aortic stenosis
-congenital/Bicuspid
-calcific (age related)
-endocarditis
-rheumatic
Critical valve area
0.5 cm squared
Causes of aortic regurgitation
-Rheumatic – more common with regurgitation than stenosis
-Endocarditis
-Aortic root disease- dilation
-Marfan’s, syphilis
Treatment of mitral stenosis
-Percutaneous balloon valvuloplasty
-Open mitral commissurotomy
-MVR (especially if with pulmonary HTN)