1.

EVH

A. reduced risk of infection and wound complications;less

postoperative pain and swelling;and faster recovery with
minimal scarring. // decreased leg wound morbidity,
improved cosmetic results, and enhanced patient
satisfaction.
B. There were significantly higher rates of vein-graft failure and

occlusion among patients who underwent endoscopic harvesting

and among the grafts harvested with the use of an endoscopic
technique than among patients who underwent open harvesting
and among grafts harvested with an open technique; concerns

persist regarding risk of injury at the time of EVH with

its potential detrimental effect on vein graft patency
and clinical outcomes
C. The heart pumps oxygenated blood to the body and
deoxygenated blood to the lungs. In the human heart there is
one atrium and one ventricle for each circulation, and with
both a systemic and a pulmonary circulation there are four
chambers in total: left atrium, left ventricle, right atrium and
right ventricle. The right atrium is the upper chamber of the
right side of the heart. The blood that is returned to the right
atrium is deoxygenated (poor in oxygen) and passed into the
right ventricle to be pumped through the pulmonary artery to
the lungs for re-oxygenation and removal of carbon dioxide.
The left atrium receives newly oxygenated blood from the
lungs as well as the pulmonary vein which is passed into the
strong left ventricle to be pumped through the aorta to the
different organs of the body.
D. Several disposable and reusable EVH systems with
and without carbon dioxide insufflation are available
2. IABP

A. a technique for assisting the circulation and decreasing the work

of the heart, by synchronizing the force of an external pumping
device with cardiac systole and diastole.// intra-aortic balloon
(IAB) counterpulsation circulatory support provided by a
balloon inserted into the thoracic aorta, inflated during diastole
and deflated during systole.

B. The following situations may benefit from this device. [2][3][4]

Cardiogenic shock when used alone as treatment for myocardial

infarction. 9-22% survive the first year.
Reversible intracardial mechanical defects complicating infarction,
i.e. acute mitral regurgitation and septal perforation.
Unstable angina pectoris benefits from counterpulsation.
Post cardiothoracic surgerymost common and useful is
counterpulsation in weaning patients from cardiopulmonary bypass
after continued perioperative injury to myocardial tissue.
Preoperative use is suggested for high-risk patients such as those
with unstable angina with stenosis greater than 70% of main
coronary artery, in ventricular dysfunction with an ejection fraction
less than 35%.
Percutaneous coronary angioplasty
In high risk coronary artery bypass graft surgery where
cardiopulmonary bypass time was shortened, as well as during
intubation period and hospital stay.[8]
Thrombolytic therapy of acute myocardial infarction.[6]

Absolute contraindication[edit]
The following conditions will always exclude patients for treatment:
[2] [3] [4]

Severe aortic valve insufficiency

Aortic dissection
Severe aortoiliac occlusive disease

Relative contraindication[edit]
The following conditions make IABP therapy inadvisable except
under pressing circumstances:[2]
Prosthetic vascular grafts in the aorta
Aortic aneurysm
Aortofemoral grafts
C.
The leg is at highest risk of becoming ischemic if the femoral
artery it is supplied by becomes obstructed. Placing the
balloon too distal from the arcus aortae may induce
occlusion of the renal artery and subsequent renal failure.
Other possible complications are cerebral embolism during

insertion, infection, dissection of the aorta or iliac artery,

perforation of the artery and hemorrhage in the mediastinum.
Mechanical failure of the balloon itself is also a risk which
entails vascular surgery to remove under that circumstance.
After balloon removal there is also a risk of 'embolic shower'
from micro clots that have formed on the surface of the
balloon, and can lead to peripheral thrombosis, myocardial
ischemia, hemodynamic decompensation, and late
pseudoaneurysm.[2] [3] [4]
D. The nurse needs to focus on issues specific to the IABP. Common
complications may include limb ischemia, thrombocytopenia,
hemolysis, bleeding from the insertion site, balloon rupture,
compartment syndrome, infection and aortic dissection. Monitor the
insertion site for any bleeding or hematoma, both anteriorly and
posteriorly. Instruct the patient not to move the leg in which the balloon
is inserted. After the balloon is removed, pressure has to be applied to
the insertion site to stop the bleeding and allow distal perfusion of the
extremity. The nurse must constantly monitor the patient for the
presence of chest, back or flank pain; this could indicate aortic
dissection. Continued patient assessment is imperative to provide
optimal care.
3. Ablation
a. Symptomatic AF patients undergoing cardiac surgery

(IIA-A).
Asymptomatic AF patients undergoing cardiac surgery in
whom the ablation can be performed with minimal risk (IIB-C).
Patients with stand-alone AF who have failed catheter
ablation and in whom minimally invasive surgical ablation is
feasible (IIB-C).
b.
OPCAB DEVICE