[02.08] SUR - Surgery for CAD and VHD V2.pdf

Ischemic heart disease

What is the number one global cause of death according to the WHO in 2016?

Ischemic heart disease or coronary artery disease

What is another name for the cardiac disease characterized by progressive atherosclerotic occlusion of the coronary arteries?

Diseases of the heart

What is the number one cause of mortality in the Philippines according to the DOH in 2013?

Rheumatic conditions

What is the most common etiology leading to valvular heart disease in the Philippines?

Pediatric population

In which specific patient population is congenital heart disease highly prevalent?

Tumors and arrhythmia

What are two miscellaneous surgical cardiac conditions mentioned in the text?

Atrial fibrillation and ventricular tachycardia

What are two specific tachyarrhythmias listed under miscellaneous surgical heart diseases?

Heart blocks requiring pacemaker insertion

What electrical conduction abnormality is listed as a miscellaneous surgical heart condition?

Older age, cigarette smoking, hypertension, diabetes mellitus, dyslipidemia, obesity, and sedentary lifestyle

What are the seven major risk factors listed for coronary artery disease?

Passive smoking

What specific type of non-active tobacco exposure is explicitly listed under coronary artery disease risk factors?

69.38 years

What was the life expectancy for Filipinos in 2018?

Age

What independent risk factor for cardiovascular disease is linked to the onset of diabetes mellitus and hypertension?

Urbanization

What socio-demographic trend in the Philippines, along with lifestyle choices, is raising the prevalence of cardiovascular disease?

Stable angina pectoris, myocardial infarction, ischemic heart failure, intractable arrhythmias, and asymptomatic

What are the five clinical presentations of coronary artery disease?

Silent myocardial infarction

What clinical event can asymptomatic coronary artery disease lead to before sudden death?

Chest x-ray

What diagnostic test is a mortal sin to omit before performing open heart surgery?

Regional wall motion abnormalities

What specific echo finding in coronary artery disease patients correlates with significant stenosis on angiography?

Hemodynamic assessments, localization of infarcts, and assessment of infarct sizes

What are three assessments performed via 2D echocardiography for coronary artery disease patients?

Left Main Coronary Artery

Which major coronary vessel bifurcates into the Left Anterior Descending and Left Circumflex arteries?

Left Anterior Descending and Left Circumflex

Into what two major branches does the Left Main Coronary Artery bifurcate?

Diagonal branches

What branches are given off by the Left Anterior Descending artery?

Marginal branches

What branches are given off by the Left Circumflex artery?

Right Posterior Descending and Posterolateral arteries

What two branches are given off by the Right Coronary Artery?

LAD, LCx, and RCA

What are the three major coronary arteries of the heart?

70% or greater

What percent occlusion is considered significant stenosis in the LAD, LCx, or RCA?

50% or greater

What percent occlusion is considered significant stenosis in the Left Main Coronary Artery?

Coronary artery bypass grafting

What is the most common cardiac surgery performed worldwide?

Vineberg Operation

What was the name of the 1950s surgical revascularization procedure that implanted the internal thoracic mammary artery directly into the myocardium?

Dr. Gibbon

Who invented the first heart-lung machine?

1953

In what year was the first heart-lung machine first used?

Senning

Who performed the first vein patch for arteriotomy in 1961?

Sabiston and Favaloro

Which two surgeons performed early CABG using the saphenous vein in 1962 and 1967?

Green

Which surgeon first used the left internal mammary artery for the left anterior descending artery in 1968?

Class I

What ACC/AHA classification denotes that a procedure is beneficial, useful, and effective based on expert agreement?

Class II

What ACC/AHA classification represents conflicting evidence or divergence of opinion regarding a procedure?

Class IIA

What ACC/AHA subclass denotes that the weight of evidence or opinion is in favor of usefulness or efficacy?

Class IIB

What ACC/AHA subclass denotes that usefulness or efficacy is less well established by evidence or opinion?

Class III

What ACC/AHA classification indicates expert agreement that a procedure is not useful or effective and may be harmful?

Class I or Class IIA

At what ACC/AHA recommendation classes is surgical revascularization carried out?

Level of Evidence A

What level of evidence is derived from multiple randomized clinical trials or meta-analyses?

Level of Evidence B

What level of evidence is derived from a single randomized trial or non-randomized trials?

Level of Evidence C

What level of evidence is derived only from consensus opinion of experts, case studies, or standard-of-care studies?

Level of Evidence B

What is the level of evidence for Left Main involvement, 3-vessel disease, and 2-vessel disease indications for Class I CABG?

Level of Evidence A

What is the level of evidence for unacceptable angina with more than one stenosis amenable to revascularization despite medical treatment?

Postinfarction complications

For what complications, such as ventricular septal rupture or papillary muscle rupture, is CABG indicated after acute MI?

Cardiogenic shock

What life-threatening state of low cardiac output after acute MI is a Class I indication for CABG with Level B evidence?

3-vessel disease or Left Main stenosis greater than 50%

What anatomical CAD findings must coexist with life-threatening ventricular arrhythmias of ischemic origin to warrant Class I CABG?

Preoperative prophylactic antibiotics

What type of medication is routinely administered before CABG surgery as a preventive measure?

General anesthesia

Under what type of anesthesia is a patient put before undergoing CABG?

Midline exposure

What surgical exposure technique uses a sternal saw to split the sternum?

Internal Mammary Artery, Saphenous Vein Graft, Radial Artery, and Gastroepiploic Artery

What are the four common vascular conduits harvested for CABG?

Left Internal Mammary Artery

What is the most popular conduit used in CABG surgery?

Left Anterior Descending artery

To which coronary artery is the Left Internal Mammary Artery graft usually attached?

Greater than 90%

What is the 10-year and 20-year long-term patency rate of LIMA grafts?

Right Internal Mammary Artery

Which conduit has increasing popularity in multi-arterial CABG and is reserved for the most occluded vessel?

Endoscopic Vein Harvesting

What does the acronym EVH stand for regarding saphenous vein grafting?

Small incision at the lower thigh

Where is the incision made for Endoscopic Vein Harvesting?

Islet incisions

What is the term for saphenous vein graft dissection performed with separated thigh and leg incisions leaving islands of skin in between?

ROOBY trial

What randomized clinical trial compared endoscopic versus open saphenous vein harvesting?

Open conventional technique

Which harvesting technique was shown by the ROOBY trial to have superior saphenous vein graft patency at 1 year?

Dr. Avenilo P. Aventura, Sr.

Who performed the first CABG in the Philippines in 1972?

Philippine Heart Center

Of which national medical institution was Dr. Avenilo P. Aventura the first medical director?

50% to 60%

What is the 10-to-15-year patency rate of a Saphenous Vein Graft?

88%

What is the 4-to-5-year patency rate of a LIMA graft?

96%

What is the 4-to-5-year patency rate of a RIMA graft?

Conventional CABG

Which type of CABG uses a heart-lung machine or cardiopulmonary bypass machine?

Off-pump CABG

Which type of CABG does not use a heart-lung machine or cardiopulmonary bypass machine?

Cardiopulmonary bypass

What is the full name of the CPB machine used as a form of extracorporeal circulation?

Motionless and bloodless field

What optimal surgical environment does cardiopulmonary bypass provide to facilitate open heart surgery?

Circulation, oxygenation, carbon dioxide elimination, and systemic cooling

What are the four functions assured by the cardiopulmonary bypass machine?

Aorta

Into which major vessel is blood flow diverted away from during CPB to avoid circulation to the heart and lungs?

Heart

What organ's function is temporarily taken over by the pump component of the CPB machine?

Lungs

What organ's function is temporarily taken over by the oxygenator component of the CPB machine?

Red tip tubing

Which lines in the CPB circuit carry oxygenated arterial blood back to systemic circulation?

Blue tip tubing

Which lines in the CPB circuit carry deoxygenated venous blood away to the oxygenator?

Prime

What is the term for the fluid used to prime the oxygenator and circuits before starting CPB?

Perfusionist

What is the title of the healthcare professional who operates the cardiopulmonary bypass machine during surgery?

Hypothermia

What physiological state is induced by cooling the patient to 28-34 degrees Celsius to slow metabolism before CPB?

Cardioplegic solutions

What solutions are injected into the heart through the aorta to arrest it after cross-clamping?

Crystalloid, colloid, and blood

What are the three forms of cardioplegic solutions used during CABG?

Antegrade cardioplegia

Which cardioplegia delivery route injects solutions via the aortic route into the coronary ostia at the base of the aorta?

Retrograde cardioplegia

Which cardioplegia delivery route injects solutions via the venous system through the coronary sinus?

Distal anastomosis

Which anastomosis of a saphenous vein graft is performed first during conventional CABG?

Proximal anastomosis

Which anastomosis of a saphenous vein graft connects the conduit to the aorta?

Intraoperative Transit Time Flowmetry

What quality control measure, also known as graft flow measurement, is performed to assess graft patency before getting off CPB?

1.9%

What was the STS database mortality rate for conventional CABG in 2009?

Less than 1%

What was the conventional CABG mortality rate at the Cleveland Clinic in 2017?

Greater than 2%

What is the conventional CABG mortality rate at the Philippine Heart Center?

1.2%

What is the postoperative stroke rate following conventional CABG according to the 2009 STS database?

2.2%

What postoperative percentage of conventional CABG patients require operation for mediastinal bleeding?

0.37%

What is the postoperative rate of deep sternal wound infection after conventional CABG?

SYNTAX trial

Which randomized clinical trial compared the 5-year outcomes of CABG versus PCI in patients with three-vessel or Left Main disease?

Lesion complexity and location

On what two factors is the SYNTAX scoring system based to classify coronary artery disease severity?

Low score

Which SYNTAX score category (0-22) represents comparable rates of death, stroke, and MI between CABG and PCI but more revascularizations with PCI?

Intermediate score

Which SYNTAX score category (23-32) showed significantly higher rates of repeat MI and revascularization with PCI compared to CABG?

High score

Which SYNTAX score category (33 or greater) showed significantly higher rates of death, MI, and repeat revascularization with PCI?

71%

What percentage of patients with complex multi-vessel CAD are still best treated with CABG according to the SYNTAX trial?

Bilateral Internal Mammary Artery

What does the abbreviation BIMA stand for in multi-arterial CABG?

No-touch saphenous vein harvesting

In which saphenous vein harvesting technique is the perivascular tissue or fat around the vein retained?

83%

What is the 16-year patency rate of a saphenous vein graft harvested using the no-touch technique?