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Cardiac Surgery
Cardiac Surgery
INTRODUCTION:
1944: Alfred Blalock, Helen Taussig, and Vivien Thomas performed the
first successful palliative paediatric cardiac operation, in a one-year-old
girl with Tetralogy of Fallot.
In 1947, Thomas Sellors operated on a Tetralogy of Fallot patient with
pulmonary stenosis and successfully divided the stenosed pulmonary
valve.
Many thousands of these "blind" operations were performed until the
introduction of cardiopulmonary bypass made direct surgery on valves
possible
CONT…
Risk increases with age and when the individual has other health
problems such as DIABETES,CHRONIC KIDNEY FAILURE,
CHRONIC LUNG DISEASE, PULMONARY EDEMA, CHF,
ELECTROLYTE IMBALANCES, ALCOHOLISM and PRIOR
HISTORY OF HEART ATTACK OR STROKE.
DESCRIPTION:
Cardiac surgery is done to correct many different types of heart conditions. The most common are:
REVASCULARIZATION. (Eg: CABG)
▪ TO TREAT,
CONGENITAL HEART DEFECTS (Eg: ASD CLOSURE)
CORONARY ARTERY DISEASE
VALVULAR DISORDERS (Eg: MVR)
ARRHYTHMIAS
ANEURYSM REPAIR
REMOVAL OF ANY CARDIAC TUMORS (Eg: ROBOTICALLY ASSISTED SURGERIES)
END STAGE HEART FAILURE REQUIRING HEART TRANSPLANTATION
TYPES OF CARDIAC SURGERY:
MEDIAN STERNOTOMY.
PACEMAKER INCISION
THORACOTOMY :
POSTEROLATERAL THORACOTOMY
ANTEROLATERAL THORACOTOMY
AXILLARY THORACOTOMY
LATERAL THORACOTOMY
SUBXIPHOID (PERICARDIAL WINDOW)
CHOICE OF INCISION:
▪ UNDERLYING PATHOLOGY.
▪ THE SITE (EG: LUNG,CHEST WALL, OESOPHAGUS).
▪ EXPERIENCE OF THE SURGEON.
SURGERY : At the level of the 5th rib for exposure of the upper thoracic
area,
At the level of the 6th or 7th rib for lower thoracic area (eg:
lower oesophageal or diaphragmatic surgery).
MEDIAN STERNOTOMY:
MEDIAN STERNOTOMY:
▪ ADVANTAGE:
The advantages of this incision are that it is quick to perform, especially in
hemodynamic emergencies, and it produces less pain than a traditional thoracotomy.
The main drawback is cosmetic, and a risk of sternal mal-union exists, which is
usually associated with a postoperative infection.
It can predispose to significant scar formation and chronic chest pain, also Brachial
plexus injury may occur.
PACEMAKER INCISION:
PACEMAKER INCISION:
ANS:
① Midline
sternotomy,
② Pacemaker scar,
③ Posterolateral
thoracotomy,
④ Anterolateral
thoracotomy,
⑤ Axillary
thoracotomy
PREOPERATIVE
ASSESSEMENT AND CARE
PREOPERATIVE ASSESSMENT AND CARE:
HISTORY
EXAMINATION
INVESTIGATION
HISTORY TAKING:
▪ Blood tests(CBC): check for anemia (low iron) , chemical (electrolyte) imbalances in the
blood, blood glucose level and HbA1C.
▪ Serum electrolyte.
▪ Urine analysis.
▪ Coagulation screening. (CLOTTING TIME AND BLEEDING TIME).
▪ ABG
▪ PFT
▪ Chest x ray: non-invasive test shows if fluid is building up in the lungs or if the heart is
enlarged.
▪ Electrocardiogram (EKG): non-invasive test helps detect abnormalities in heart rhythm
and heart health by measuring the electrical activity of the heart
▪ Echocardiogram: non-invasive imaging test that produces a picture of the heart in
motion as it beats; extremely helpful in showing heart and valve damage
▪ Kidney function tests: help pinpoint the cause of fluid retention
▪ Stress test: an electrocardiogram done while exercising or, for people who cannot
exercise, while the heart is stimulated by medication.
▪ Transesophageal echocardiography: a diagnostic test using an ultrasound device
that is passed into the esophagus of the patient to create a clear image of the heart
muscle and other parts of the heart
▪ Angiogram: an x-ray (radiographic) study of the blood vessels. An angiogram
uses a radiopaque substance, or contrast medium, to make the blood vessels
visible under x ray
PRE OPERATIVE PREPARATION IMMEDIATELY BEFORE SURGERY:
▪ INFORMED CONSENT.
▪ SURGEON AND ANAESTHETIST MEET PT PRIOR TO SURGERY TO
IDENTIFY THE PT AND CONFIRM THE SURGERY.
▪ NPO FOR 6-8 HRS.
▪ PLACEMENT OF URINARY CATHETER.
▪ ANTIBIOTICS GIVEN AN HOUR PRIOR BEFORE SURGICAL
INCISION.
▪ START OF IV LINEAND FLUID MGT.
▪ PREPARATION OF PARTS.
PRE OP MODIFICATION OF TREATMENT:
▪ Anticoagulants - These are tailed off over a few days prior to operation.
▪ Aspirin and Clopidogrel- This has a significant effect in diminishing platelet function and
can lead to increased postoperative blood loss. Ideally it should be stopped 7-10 days
before surgery, if not, should be stopped on the day of admission of the patient - unless
there is unstable angina.
▪ Digoxin - Continued until the day before operation.
▪ Diuretics and Potassium Supplements - Continued until the day before operation
▪ B BLOCKERS -to continue them until the day before operation.
▪ Anti Hypertensives - Maintain until operation
▪ ANTI PLATELET: Should be withdrawn a week before surgery.
▪ Depending on the procedure after care is given.
Complications:
Excessive bleeding, infection, and a negative reaction to anaesthesia.
Other complications include the development of kidney failure, heart
arrhythmias , heart attack, blood clot formation, and stroke during or soon
after the procedure. Death is possible and occurs in about 3% of patients who
have cardiac bypass surgery and valve replacement surgery.
CONNEXIONS:
Connexions:
Connexions: