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Alternative to CV Su
Harry Hoerr; Alternative Approaches to Cardiac Surgery
| Question | Answer |
|---|---|
| What is the average life expectancy in the US? | 77.3 years |
| If you were to eleminate all forms of CV disease how much would life expectancy increase? | CV disease-7 yearsCancer-3 years |
| How many congenital CV defects in 1000 births? | 9.0 defects per 1000 births |
| What is the most common Congential CV defect? | 1.VSD 2.ToF 3.Transposition of great arteries 4.Coarctation of aorta 5.ASD |
| What CV procedure cost the most? | 1.Heart Valves ($85,187) 2.CABG ($60,853) |
| in 1929 he had the first documented human cardiac catheterization? | Dr. Werner Forssmann |
| Who Employed cardiac catheter as diagnostic tool for the first time? 1941 | Cournand & Richards |
| Who developed the concept of the diagnostic coronary angiogram? | Mason Sones |
| Who performed the first saphenous vein graft surgery in Cleveland? 1967 | Dr. Rene Favaloro |
| Who performed the first peripheral human balloon angioplasty? 1974 | Andreas Gruentzig(first cath lab PTCA of awake patient) |
| Fist use of stents in humans (1986) | Puel & Siwart |
| What is a PTCA? | Percutaneous translumonal coronary angioplasty: Balloon advanced to blockage and inflated. Plaque pushed against vessel wall. Small crakcs created w/ plaque an artery stretched. |
| What is the criteria for coronary angioplasty? | -BAlloon can be passed through the blockage. -Blockage can be reached by catheter. -Blocked vessel is NOT the left main. -Patient is not in heart failure. -Patient is having a heart attack w/in 2 to 6 hours of onset. |
| What are som advantages of coronary angioplasty? | -Less invasive than bypass surgery. -Low Risk. -Low Cost. -LA versus general. -Percutaneous incision. -Patient able to return to normal activity shortly after procedure. |
| What are some risks and complications of coronary angioplasty? | -Bleeding from insertion site. -Damage to the insertion artery or coronary artery by catheter. -Restenosis. -Sudden vessel closure. -Stents may cause clot formation. -Infection. -Allergic to dye. -MI. -Death. -Stroke. (need for emergent Bypass) |
| What are the restenosis rates of PTCA? | 10% to 40% during first six months |
| What are the restenosis rates of bare metal stents? | 30% - 50% during first six months |
| What are the restenosis rates of drug eluting stents? | 7% to 15% during first six months |
| What are some things you must think about when placing a stent? | -Stent must cover the complete lenght of blockage. -Stent must be fully expanded so there are no gaps between the surface of the plaque and the stent. |
| What kind of drug is used in Boston Scientific Stents? | Chemotherapeutic Drug |
| What do Johnson & Johnson use in the stents? | Immunosuppressive agent |
| What may atherectomy work best on? | Complex Lesions; -heavily calified/fibrotic/undilatable lesion. -Ostial & branch-ostial lesions. -Chronic total occlusions. -in-stent restenosis |
| What are the different types of atherectomy devices? | -Directional. -Rotational. -Transluminal extraction. |
| What is directional Atherectomy and what are its RPM? | -PErcutaneous over-the-wire cutting and retrieval system. -Cuttin window placed toward the plaque-balloon inflated pushing plaque into cutting cup. -2,000 RPMs |
| What is rotational atherectomy and what are its RPMs? | -Elliptical-shapes brass burr coated with 5-10 micron diamond chips. Saline flush solution infused into the plastic sheath around the drive shaft to minimize frictional heat. -Burr ablates and pulverizes inelastic plaque tissue. 140-190,000 RPMs |
| What is transluminal extraction atherectomy and what are its RPMs | -Percutaneous over-the-wire cutting and aspiration system. -Head with two stainless blades. -Lactated Ringers solution flushed into area creates particulate slurry that is suctioned back through the catheter. -750 RPMs |
| What is transluminal angiogenesis? | -May be best for patient who are not canidates for angioplasty or surgery. -Guide laser into LV (burn small channels directly into the myocardial wall). -May promote growth of small new blood vessels. |
| What are some surgical techniques for CABGs? | -CPB. -Without bypass. -Assisted perfusion. -Minimal CABG w/ CPB. -Robotically |
Created by:
allievisner2
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