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19 Cards in this Set
- Front
- Back
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Who benefits most from surgery for ischaemic heart disease?
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Those with the highest risk
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How is risk determined?
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By the severity of angina
Extent of the disease Presence of LV function |
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What is an alternative to surgery?
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Percutaneous treatment
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What are the different forms of percutaneous treatment?
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PCTA
Stents |
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What are the objectives of CABG?
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Prolong survival
Restore QOL Preserve LV function Prevent MI Relieve ischaemia |
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What are the indications for CABG? (10)
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Severity of symptoms
Unstable angina Failed PTCA Impairment of LV function Acute MI with shock Post- infarction angina Triple vessel disease Left main disease Extent of disease Failure of medication |
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Before coronary vascularisation is undertaken, what pre- op evaluations need to be done?
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Pulmonary function tests
Full Hx CXR FBC/ U+Es/ LFTs/ Coag/ Cross match Carotid duplex scan |
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What are the specific investigations that need to be completed before the operation?
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ECG
ETT Coronary angiogram (Stress echo, perfusion scan) |
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What are the different approaches that can be taken with coronary revascularisation?
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Cardioplegic arrest
Bypass of major vessels with >50% stenosis Cardiopulmonary bypass Anastomosis of conduit onto coronary artery beyond point of stenois |
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What is involved in a cardiopulmonary bypass?
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Motionless, decompressed heart
Stable, bloodless operative field Good access and visualisation of coronary field arteries |
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What are the vessels that can be used for anastomosis?
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Gastroepiploic A
Radial A Internal Mammary A Long saphenous V Inferior Epigastric A |
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Why is the long saphenous used?
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Patency: 80% at 1 month/ 50% at 10 years
Good handling Ease of harvest |
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Why is the Inferior Epigastric artery used?
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Patency: ?
Abdominal incision Stable vasoactively Infrequent use |
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Why is the Internal Mammary used?
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Patency: 99% at 1 month/ 95% at 10 years
Single/ Bilateral Ease of harvest |
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Why is the Radial used?
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Patency: 80-85% at 5 years
Decreased morbidity Allen's test |
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Why is the Gastroepiploic used?
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Patency: ?
Highly vasoactive Limited use Abdominal incision |
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What is used to predict the operative risk?
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Number of major vessels with >70% stenosis
LV dysfunction Presence of left main artery stenosis Prior heart surgery Urgency of operation PARSONNET/ EURO score |
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What is the outcome of coronary revascularisation?
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Freedom from angina = 60% at 10 years
Hospital mortality = 3% 10 year survival = 75% 5 year survival = 88% Freedom from re operation = 90% at 10 years |
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What are the potential post operative complications of CAD surgery? (12)
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Wound infection (3%)
Arrhythmias Tamponade (<1%) Neuropsychological deficit (30-50%) TIA/ CVA Bleeding Sternal Deniscence Decreased cardiac output (<1%) Mediastinitis Renal complications (2-5%) Prolonged ventilation (2%) Pulmonary infection (5%) Peri- op MI (2-3%) |
