CABG
First off, I'd like to start off with saying that this study guide was ridiculously hard for me
to do...so sorry if it's got a lot of junk on it. I try to simplify the power points, but this one
was hard to do because of all the information and she basically just read from it straight in
class. 2nd...I changed the order of some stuff because she jumped around. I organized it
things that needed to be together...are. So don't get your panties in a wad...it's all here!
REVASCULARIZATION- Use of conduit or channel used to bypass an occluded
area..... FYI: Arteries have a better patency than veins.
TYPES:
Internal Mammary Artery (IMA)
- Right and left can be used.
-DO NOT USE IF IN EMERGENCY BC OF TIME!!!!!!!
-patency results are higher than the SVG
Radial Artery
-increase patency to 90% or better with post Op CCB's (-pines) in order to
keep minimal vasospasm!!
SVG-.....both of these...I have no idea what the hell she is talking about. So..if
someone does...holla atcha gurl!
GEA............basically the point of these last 2 is they are just different routes...I
highly doubt that she will ask about these...she will ask about the IMA.......
Minimally Invasive Direct Coronary Bypass (MIDCAB)
-1 to 2 bypasses on one to two coronary arteries on the anterior surface of the heart
-DO NOT NEED STERNOTOMY OR CORONARY PULMONARY BYPASS
-Thorascope directed through several small incisions to dissect the IMA and suture to
LAD or RCA....you can use the radial artery or saphenous vein!!
, -Heart is slowed down by BB (esmolol) or stops it temporarily with Adenosine then pt
immobilized by mechanical
stabilizer.
-reduces length of stay, cost, and that thing that starts with a D....and ends with an H
-Watch out for Alt. Tissue Perfusion and Hemorrhage!!!!!!
Transmyocardial Laser Revascularization (TMR)
-The pt. that can get this are the ones with advanced CAD who are unable to get a CABG,
BUT have persistent chest pain despite drugs!!!
-performed during heart cath or surgically through L anterior thoracotomy
-High-energy laser triggered to create a channel between LV cavity and coronary
microcirculation.
Off Pump Coronary Artery Bypass (OPCAB)
-Candidates: low EF, Severe lung disease, AKD/CKD, CVA, calcified aorta
-uses full or partial sternotomy to access all coronary arteries
-performed on a BEATING HEART....unlike the MIDCAB...but uses
mechanical stabilizers, too......NO BYPASS!!! bc DUH...it causes
a lot of
problems.
IGHT...NOW WE GO INTO THE ACTUAL CABG STUFF FO SHIZZLE....
CABG
Incision
2nd surgeon isolating Saphenous Vein
Prepare for cannulation of superior/inferior aorta
BEGIN CARDIOPULMONARY BYPASS (CPB)
Cross clamp aorta!!!!....ischemic time is usually 60min....OR 10-12 min. per graft.
SURGEON SKILL + TIME = THE DR. OTHER THAN DRE
THAT I'D WANT TO OPERATE ON ME.
Give Cardioplegia....heart paralyzing agent (liquid)
-composed of K,CA,Mg,NA, and albumin that is infused thru coronary arteries
First off, I'd like to start off with saying that this study guide was ridiculously hard for me
to do...so sorry if it's got a lot of junk on it. I try to simplify the power points, but this one
was hard to do because of all the information and she basically just read from it straight in
class. 2nd...I changed the order of some stuff because she jumped around. I organized it
things that needed to be together...are. So don't get your panties in a wad...it's all here!
REVASCULARIZATION- Use of conduit or channel used to bypass an occluded
area..... FYI: Arteries have a better patency than veins.
TYPES:
Internal Mammary Artery (IMA)
- Right and left can be used.
-DO NOT USE IF IN EMERGENCY BC OF TIME!!!!!!!
-patency results are higher than the SVG
Radial Artery
-increase patency to 90% or better with post Op CCB's (-pines) in order to
keep minimal vasospasm!!
SVG-.....both of these...I have no idea what the hell she is talking about. So..if
someone does...holla atcha gurl!
GEA............basically the point of these last 2 is they are just different routes...I
highly doubt that she will ask about these...she will ask about the IMA.......
Minimally Invasive Direct Coronary Bypass (MIDCAB)
-1 to 2 bypasses on one to two coronary arteries on the anterior surface of the heart
-DO NOT NEED STERNOTOMY OR CORONARY PULMONARY BYPASS
-Thorascope directed through several small incisions to dissect the IMA and suture to
LAD or RCA....you can use the radial artery or saphenous vein!!
, -Heart is slowed down by BB (esmolol) or stops it temporarily with Adenosine then pt
immobilized by mechanical
stabilizer.
-reduces length of stay, cost, and that thing that starts with a D....and ends with an H
-Watch out for Alt. Tissue Perfusion and Hemorrhage!!!!!!
Transmyocardial Laser Revascularization (TMR)
-The pt. that can get this are the ones with advanced CAD who are unable to get a CABG,
BUT have persistent chest pain despite drugs!!!
-performed during heart cath or surgically through L anterior thoracotomy
-High-energy laser triggered to create a channel between LV cavity and coronary
microcirculation.
Off Pump Coronary Artery Bypass (OPCAB)
-Candidates: low EF, Severe lung disease, AKD/CKD, CVA, calcified aorta
-uses full or partial sternotomy to access all coronary arteries
-performed on a BEATING HEART....unlike the MIDCAB...but uses
mechanical stabilizers, too......NO BYPASS!!! bc DUH...it causes
a lot of
problems.
IGHT...NOW WE GO INTO THE ACTUAL CABG STUFF FO SHIZZLE....
CABG
Incision
2nd surgeon isolating Saphenous Vein
Prepare for cannulation of superior/inferior aorta
BEGIN CARDIOPULMONARY BYPASS (CPB)
Cross clamp aorta!!!!....ischemic time is usually 60min....OR 10-12 min. per graft.
SURGEON SKILL + TIME = THE DR. OTHER THAN DRE
THAT I'D WANT TO OPERATE ON ME.
Give Cardioplegia....heart paralyzing agent (liquid)
-composed of K,CA,Mg,NA, and albumin that is infused thru coronary arteries
