冠状动脉搭桥术CABGPPT课件.ppt

1、Coronary Artery Bypass Grafting1Definition Indication ContraindicationCABG Types Graft chooseComplications2医者仁心 一路相随 With You All The WayWhat is CABG?p Coronary artery bypass graft surgery (CABG) is a procedure that uses patients own veins (usually from the legs) or arteries to bypass narrowed areas

2、 and restore blood flow to heart muscle. p Bypass surgery can markedly reduce or relieve chest pain for most patients, and improve survival and minimize complications of cardiac ischemiap More than 300,000 patients undergo CABG surgery annually in the US3医者仁心 一路相随 With You All The Way4医者仁心 一路相随 With

3、 You All The WayAHA Guideline for CABG SurgeryLeft main coronary artery disease (LMCA) or significant disease of the LAD with another vessel involved or all three coronary arteries (LAD, LCX and RCA).Diffuse disease not suitable to treatment with a PCI or stent placement is not successful in opening

4、 the blocked blood vesselsSurvivors of sudden death who have coronary artery diseaseOther high-risk patients such as those with severe ventricular dysfunction (i.e. low ejection fraction), or diabetes mellitus.CABG is superior to PCI for some patients with multivessel CAD医者仁心 一路相随 With You All The W

5、ayCABG is not recommended for patients who do not have adequate native vessels to use as graft. Patients with very small coronary arteries( 1 mm or 1.5 mm) and atherosclerosis of the aorta, heavily calcified, or located within the heart muscle rather than on the surface are challenges in CABG. CABG

6、Contraindication医者仁心 一路相随 With You All The WayCABGTraditional CABGNontraditional CABGOff Pump Coronary Artery Bypass GraftingMinimally Invasive Direct Coronary Artery Bypass Grafting Types of CABG医者仁心 一路相随 With You All The WayOff Pump Coronary Artery Bypass Grafting医者仁心 一路相随 With You All The WayOff

7、Pump Coronary Artery Bypass GraftingAdvantages:A decreased need for blood transfusionLess myocardial enzyme releaseLess renal dysfunctionLess early neurological dysfunctionDisadvantage:Decreased graft patency due to problems with anastomoses9医者仁心 一路相随 With You All The WayChoice of Graft Internal tho

8、racic arteries (also called internal mammary arteries) Radial arteries Saphenous veins Right gastroepiploic artery医者仁心 一路相随 With You All The Wayl Saphenous vein graft patency declines significantly starting at the time of surgery. Rates below 90 percent are common at one year. l Long-term graft pate

9、ncy is excellent with internal thoracic artery and radial artery bypass grafts. Rates exceeding 90 percent at 5 to 10 years are common.l Graft patency is dependent on a number of factors, including the type of graft used, the size of the coronary artery that the graft is anastomosed with, and the sk

10、ill of the surgeon(s) performing the procedure. Blood flow begins to diminish with around a 70 percent stenosis in the graft. 医者仁心 一路相随 With You All The WayBleeding that may require a return to the operating roomHeart attack or heart failure or arrhythmiaStroke or changes in cognitive functionPulmon

11、ary problems;Wound infection Renal failure; Death.Bypass Surgery Complications医者仁心 一路相随 With You All The WayCardiac complicationsAtrial fibrillation：40 %Sustained ventricular tachycardia or ventricular fibrillation:2 to 3 %Postoperative bradycardia：0.8 to 4 %Pericarditis or Cardiac tamponadeBypass C

12、omplications: Cardiac complications 医者仁心 一路相随 With You All The WayApproximately 30% of patients require a blood transfusion after CABG. Only about 2 percent of people require surgery to stop excessive bleeding.Medication should discontinued prior to surgery: Aspirin: 2-3days Plavix: 5-7 days Tirofib

13、an: 4 to 6 hours Warfarin: Four days Unfractionated Heparin: D/C at the time of surgery Low molecular weight heparin 12 to 24 hours prior to surgeryBypass Surgery Complications: Bleeding医者仁心 一路相随 With You All The WayStroke or DepressionPost-op deliriumShort- and long-term cognitive changesBypass Com

14、plications: Neurologic complications The incidence of neurologic problems following CABG :2 to 4% Older patients and women are affected more frequently.医者仁心 一路相随 With You All The WaySternal wound infection:1 %. It usually develops by seven to nine days after surgery.Leg wounds infection: 5%, dermati

15、tis, cellulitis, nerve damage, and non-healing ulcers; most are minor and do not require surgical intervention.Catheter related infection: CVC, Swan-ganz catheter, A-line, Endotracheal tube, Foley catheterBypass Complications: Infection 医者仁心 一路相随 With You All The WayRenal failure A temporary decreas

16、e in kidney function occurs in approximately 5 to 10%.Pleural effusions: occurring in up to 90%. They are usually small and do not require treatment. Phrenic nerve damage : Numbness, tenderness, or burning discomfort over the sternum and left anterolateral chest wall. Pain usually subsides by four months.Aortic dissectionThrombocytopenia Other complications 医者仁心 一路相随 With You All The Way