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17 Cards in this Set
- Front
- Back
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Indications for CABG
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- 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 |
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2 types of grafts in CABG
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Saphenous vein
Internal mammary artery - branch of subclavian |
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Patency rate for saphenous vein graft
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50% in 10 years
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Patency rate for IMA graft
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90% in 10 years
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Where do you put saphenous vein graft
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RCA
LCX |
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Where do you put internal mammary artery graft
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LAD
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Operative mortality rate for CABG is 1-2% when patient has _
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No comorbidities
Good LV function Age< 80 |
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Risk factors for morbidity and mortality
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Age
Renal insufficiency PVD COPD Prior open heart surgery LV dysfunction Recent MI |
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Very common despite beta-blocker prophylaxis
25% post CABG 50 % post valve replacement |
Post op atrial fibrillation
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What are the risk factors of post op a fib
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Increased age
HTN Ventillator IABP |
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Treatment of post op AF, prognosis?
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Esmolol, metoprolol
Verapamil, diltiazem - 80% revert to regular sinus rhythm w/in 24 hrs |
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Treatment if post op AF lasts more than 48 hours
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Anticoagulation
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Minimally invasive CABG vs regular CABG
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-Heart still beating
-Less post op bleeding, DVT, PE, renal insuff. -Less post op pain, wound infection |
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Causes of aortic stenosis
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-congenital/Bicuspid
-calcific (age related) -endocarditis -rheumatic |
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Critical valve area
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0.5 cm squared
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Causes of aortic regurgitation
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-Rheumatic – more common with regurgitation than stenosis
-Endocarditis -Aortic root disease- dilation -Marfan’s, syphilis |
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Treatment of mitral stenosis
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-Percutaneous balloon valvuloplasty
-Open mitral commissurotomy -MVR (especially if with pulmonary HTN) |
