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Surgical Intervention for Coronary Artery Diseases

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									 Surgical Intervention for
Coronary Artery Diseases

           By
    Dr. Hanan Said Ali
    Learning Objectives
 Define coronary revascularization.
 Identify types of Coronary
  revascularization.
 Describe the following procedures:
 Percutaneous Transluminal Coronary
  Angioplasty
      and stent.
 Directional Coronary Atherectomy
  (DCA).
Learning Objectives
   Rotablation (Percutaneous Transluminal
    Rotational     atherectomy or PTRA).
    Cutting Balloon.
   Transmyocardial Laser Revascularization
    (TMLR):.
    Coronary Artery Bypass Grafting(CABG.
•   Explain the nursing management.
       Coronary revascularization
   Coronary revascularization procedures
    are usually undertaken to relieve angina
    symptoms, although some patients may be
    referred for prognostic reasons. Candidates for
    revascularization include those with evidence of
    continuing extensive ischaemia or symptoms
    that persist despite optimal medical therapy
      Coronary revascularization Cont.
1- Percutaneous Transluminal Coronary
 Angioplasty ( PTCA)
   Angioplasty is a method of treating the localized
    coronary artery narrowing by dilating the blockage
    using a special double lumen balloon catheter.

   It may be used to treat patients with recurrent chest
    pain that is unresponsive to medical therapy, those
    with atheromas that occlude at least 70% of the
    internal lumen of a major coronary artery.
       1- Percutaneous Transluminal
       Coronary Angioplasty ( PTCA)
   A balloon angioplasty procedure in which a small
    balloon at the tip of the catheter is inserted near
    the blocked or narrowed area of the coronary
    artery.

   When the balloon is inflated, the fatty plaque or
    blockage is compressed against the artery walls
    and the diameter of the blood vessel is widened
    (dilated) to increase blood flow to the heart. This
    procedure is sometimes complicated by vessel
    recoil and restenosis.
1- Percutaneous Transluminal
Coronary Angioplasty ( PTCA)
 Coronary revascularization Cont.
2- Stent
 - Coronary stent insertion is an intervention
 that is used in association with balloon
 angioplasty to open up a blocked coronary
 artery.

 - A stent is a small, metal mesh tube that acts as
 a scaffold to provide support inside the
 coronary artery.
        Percutaneous Transluminal
        Coronary Angioplasty and Stent
   A balloon catheter, placed over a guide wire, is used to
    insert the stent into the narrowed artery.

   Once in place, the balloon is inflated and the stent
    expands to the size of the artery and holds it open.

   The balloon is deflated and removed, and the stent
    stays in place permanently.

   During a period of several weeks, the artery heals
    around the stent. In this way, restenosis is somewhat
    diminished.
Coronary revascularization Cont.
Percutaneous Transluminal Coronary
Angioplasty and Stent
 Coronary revascularization Cont.



3- Directional Coronary Atherectomy (DCA)
 Atherectomy is a method of treating the
 localized coronary artery narrowing by shaving
 or cutting out the blockage.
4. Rotablation (Percutaneous Transluminal
 4. Rotablation (Percutaneous Transluminal
  Rotational Atherectomy or PTRA)
   Rotational Atherectomy or PTRA)
For heavily calcified blockages, the Rotoblation
 special catheter, with an acorn-shaped,
 diamond-coated tip, is guided to the point of
 narrowing in the coronary artery. The tip spins
 around at a high speed and grinds away the
 plaque on the arterial walls.
    4. Rotablation (Percutaneous
    Transluminal Rotational Atherectomy
    or PTRA) Cont.

   This process is repeated as needed to treat
    the blockage and improve blood flow. The
    microscopic particles are washed safely away
    in your blood stream and filtered out by your
    liver and spleen
Rotablation
tip spins at high speed to grind
plaque away
      Coronary revascularization Cont.


5. Cutting Balloon
   The cutting balloon catheter has a balloon tip
    with small blades. When the balloon is inflated, the
    blades are activated. The small blades score the
    plaque, then, the balloon compresses.

   This type of balloon may be used to treat the
    build up of plaque within a previously placed stent
    (restenosis)ses the fatty matter into the arterial
    wall.
5. Cutting Balloon
    6.Transmyocardial Laser
    Revascularization (TMLR):

   The C02 TMR therapy is a surgical procedure
    that relieves chest pain in debilitated heart
    patients. A cardiac, surgeon utilizes the laser to
    create approximately 20 to 40 channels to
    allow oxygen-rich blood to reach prove
    deprived areas of the Patient's heart.
Coronary revascularization Cont.
Coronary Artery Bypass Grafting(CABG)


   It is still major intervention in the treatment of
    patients with coronary heart disease. Current
    CABG is a surgical procedure in which a
    blood vessel from another part of the body is
    grafted to the occluded blood vessel so that
    blood can flow around the occlusion.
Coronary Artery Bypass Grafting(CABG)

Indications
 Chronic angina
 Unstable angina
 Acute myocardial infarction
 Acute failure of percutaneous
  transluminal coronary angioplasty
  (PTCA)
 Severe coronary artery disease
Coronary Artery Bypass
Grafting(CABG) Cont.
   Most common
    arteries bypassed:
    ◦ Right coronary
      artery
    ◦ Left anterior
      descending
      coronary artery
    ◦ Circumflex
      coronary artery
 Coronary Artery Bypass Grafting(CABG)
 Cont.
Conduits Used for Bypass
Saphenous vein used for bypassing
 right coronary artery and circumflex
 coronary artery
   Coronary Artery Bypass Grafting(CABG)
   Cont.

 Internalmammary artery (IMA) used for
  bypassing left anterior descending
  coronary artery
  ◦ Patency rate over 90% after 10 years

 Ifmore veins are needed, alternative sites
  such as upper extremity veins can be used
  ◦ Patency rate as low as 47% after 4.6
    years
Coronary Artery Bypass Grafting(CABG)
Cont.
     Bypass of arteries:
      ◦ Incision in target
        artery:




  Anastamosis of graft with
    artery:
Coronary Artery Bypass Grafting(CABG)
Cont.
Coronary Artery Bypass Grafting(CABG)
Cont.
  Nursing Management
Preoperative
Obtain the client’s medical and surgical
 history and perform physical examination

Client and family teaching:
 e.g Knowledge deficit related to unfamiliarity with
  diagnostic tests, preoperative preparation, and
  postoperative care.
 Anxiety related to fear of surgery.
 Nursing Management
Postoperative
 Assesses   the client to provide baseline data.

 Compare   the ventilator settings with the parameters
  set by the physician .

 Monitor    the ECG disturbance in the heart rate and
  rhythm.

 Inspect   chest tube and monitor arterial blood pressure.
    Nursing Management Cont.
   Assess the client’s fluid status frequently during
    immediate postoperative period.

   Note the client’s level of consciousness,
    neurologic status, ability to move.

   To prevent infection during changing a client’s
    dressing , the nurse should observe careful
    hand washing procedures.
    Nursing Diagnosis

   Risk for impaired gas exchange related to
    retained secretions, hypoventilation secondary
    to pain, displacement of chest tubes

   Risk for decreased cardiac output related to
    impaired ventricular contraction.

   Risk for infection related to impaired skin
    integrity.
Thank You

								
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