Ischemic Heart Disease Surgery


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Surgical treatment of Ischemic Heart Disease

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Ischemic Heart Disease Surgery

  1. 1.  Hamza J. AlGhamdi
  2. 2.  
  3. 3. IHD IHD Surgical management of complicationsSurgical Management Mitral valve reflux Post-MI VSD Acute Coronary Syndrome Left ventricular aneurysm
  4. 4.  
  5. 5.  narrowing or blockage of the coronary arteries usually caused by atherosclerosis Presents with : o Stable Angina o ACS • Unstable angina/NSTEMI • STEMI
  6. 6. History• Symptoms• Risk factors• Family Hx• Medical Hx• Surgical Hx• Drug HxExaminationInvestigation
  7. 7. TEEAngiography Echocardiography Exercise ECG ECG
  8. 8.  
  9. 9. Medical revascularization PCI CABG OPCAP
  10. 10. MedicalAs an initial management strategy in patients with stable coronary arterydisease, PCI did not reduce the risk of death, myocardial infarction, or othermajor cardiovascular events when added to optimal medical therapy. COURAGE Trial N Engl J Med 2007; 356:1503-1516April 12, 2007
  11. 11.  Interventional technique To relive the stenosis Balloon angioplasty , stenting Atherectomy Mortality <1%
  12. 12.  Significant left main artery disease Triple vessel disease Two vessel disease involving the proximal LAD Poor left ventricular functionCABG remains the standard of care for patients with three-vessel or left maincoronary artery disease, since the use of CABG, as compared with PCI,resulted in lower rates of the combined end point of major adverse cardiac orcerebrovascular events at 1 year. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.- SYNTAX trial N Engl J Med. 2009 Mar 5;360(10):961-72. Epub 2009 Feb 18
  13. 13.  Preoperative o MI from stress, anxiety or critical ischemia. Intraoperative o Myocardial failure and lack of adequate myocardial contraction at the end of bypass o Embolic infarction Postoperative o Myocardial failure o Infarction o Inadequate myocardial protection or excess fluid load. o Stroke o Arrhythmias o Wound o And other complications of open heart surgery.
  14. 14.  
  15. 15.  stabilization devices hold heart in place allowing operation while positioning devices allow the surgeon to lift the beating heart to access the lateral and posterior vessels procedure is safe and well tolerated by most patients; however, OPCAB surgery remains technically more demanding
  16. 16.  OPCAB decreases in-hospital morbidity (decreased incidence of chest infection, inotropic requirement, supraventricular arrhythmia), blood product transfusion, ICU stay, length of hospitalization, and decreased CK-MB and troponin I level no significant difference in terms of survival at 2 years, frequency of cardiac events (MI, PCI, CHF, recurrent angina, redo CABG) or medication usage compared to on-pump CABG
  17. 17.  
  18. 18.  Repair of left ventricular aneurysm Repair of post infarction VSD Acute ischemic MR Surgery for ischemic ventricular arrhythmias Transplantation Ventricular assist devices.
  19. 19.  