Surgical Intervention for Coronary Artery Diseases (1)

8/11/2019 Surgical Intervention for Coronary Artery Diseases (1)

1/31

Surgical Intervention for

Coronary Artery Diseases

By

Dr. Hanan Said Ali


2/31

Learning Objectives Define coronary revascularization.

Identify types of Coronary

revascularization.

Describe the following procedures:

Percutaneous Transluminal Coronary

Angioplasty

and stent.

Directional Coronary Atherectomy

(DCA).


3/31

Learning Objectives

Rotablation (PercutaneousTransluminal Rotational

atherectomy or PTRA).

Cutting Balloon.

Transmyocardial Laser

Revascularization (TMLR):.

Coronary Artery BypassGrafting(CABG.

Explain the nursing management.


4/31

Coronary

revascularization Coronary revascularization procedures

are usually undertaken to relieve angina

symptoms, although some patients may be

referred for prognostic reasons. Candidatesfor revascularization include those with

evidence of continuing extensive ischaemia

or symptoms that persist despite optimalmedical therapy


5/31

Coronary revascularization Cont.

1- Percutaneous Transluminal CoronaryAngioplasty ( PTCA)

Angioplasty is a method of treating the localized

coronary artery narrowing by dilating the

blockage using a special double lumen ballooncatheter.

It may be used to treat patients with recurrentchest pain that is unresponsive to medical

therapy, those with atheromas that occlude at

least 70% of the internal lumen of a major

coronary artery.


6/31

1- Percutaneous Transluminal

Coronary Angioplasty ( PTCA)

A balloon angioplasty procedure in which asmall balloon at the tip of the catheter isinserted near the blocked or narrowed area ofthe coronary artery.

When the balloon is inflated, the fatty plaqueor blockage is compressed against the arterywalls and the diameter of the blood vessel is

widened (dilated) to increase blood flow to theheart. This procedure is sometimescomplicated by vessel recoil and restenosis.


7/31

1- Percutaneous Transluminal

Coronary Angioplasty ( PTCA)


8/31


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.


9/31

Percutaneous TransluminalCoronary Angioplasty and

StentA balloon catheter, placed over a guide wire, isused to insert the stent into the narrowed artery.

Once in place, the balloon is inflated and the stentexpands to the size of the artery and holds itopen.

The balloon is deflated and removed, and thestent stays in place permanently.

During a period of several weeks, the artery heals

around the stent. In this way, restenosis is


10/31

Coronary revascularization Cont.Percutaneous Transluminal Coronary

Angioplasty and Stent


11/31


3- Directional Coronary Atherectomy (DCA)

Atherectomy is a method of treating thelocalized coronary artery narrowing by

shaving or cutting out the blockage.


12/31

4. Rotablation (PercutaneousTransluminal Rotational Atherectomy or

PTRA)

4. Rotablation (Percutaneous

Transluminal 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 thecoronary artery. The tip spins around at a

high speed and grinds away the plaque on

the arterial walls.


13/31

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


14/31

Rotablation

tip spins at high speed to

grind plaque away


15/31


5. Cutting Balloon The cutting balloon catheter has a balloon tip

with small blades. When the balloon is

inflated, the blades are activated. The smallblades score the plaque, then, the ballooncompresses.

This type of balloon may be used to treat thebuild up of plaque within a previously placedstent (restenosis)ses the fatty matter into the

arterial wall.


16/31

5. Cutting Balloon


17/31

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 deprivedareas of the Patient's heart.


18/31



19/31

Coronary Artery Bypass

Grafting(CABG)

It is still major intervention in the treatment

of patients with coronary heart disease.

Current CABG is a surgical procedureinwhich a blood vessel from another part of

the body is grafted to the occluded blood

vessel so that blood can flow around theocclusion.


20/31


Grafting(CABG)

Indications

Chronic angina

Unstable anginaAcute myocardial infarction

Acute failure of percutaneous

transluminal coronary angioplasty(PTCA)

Severe coronary artery disease


21/31


Grafting(CABG) Cont.

Most common

arteries

bypassed:

Right coronaryartery

Left anterior

descendingcoronary artery

Circumflex

coronary artery


22/31

Coronary Artery Bypass Grafting(CABG)

Cont.

Conduits Used for Bypass

Saphenous vein used for bypassing

right coronary artery andcircumflex coronary artery


23/31



Internal mammary artery (IMA) usedfor bypassing left anterior descending

coronary artery Patency rate over 90% after 10 years

If more veins are needed, alternativesites such as upper extremity veinscan be used Patency rate as low as 47% after 4.6

years


24/31



Bypass of arteries: Incision in target

artery:

Anastamosis of graftwith artery:


25/31


26/31




27/31


28/31

Nursing Management

PostoperativeAssesses 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 andrhythm.

Inspect chest tube and monitor arterial bloodpressure.


29/31

Nursing Management Cont.

Assess the clients fluid status frequentlyduring immediate postoperative period.

Note the clients level of consciousness,neurologic status, ability to move.

To prevent infection during changing aclients dressing , the nurse should observe

careful hand washing procedures.


30/31


31/31

Thank You

Surgical Intervention for Coronary Artery Diseases (1)

Documents

Transcript of Surgical Intervention for Coronary Artery Diseases (1)