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Surgical Intervention for
Coronary Artery Diseases
By
Dr. Hanan Said Ali
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Learning Objectives Define coronary revascularization.
Identify types of Coronary
revascularization.
Describe the following procedures:
Percutaneous Transluminal Coronary
Angioplasty
and stent.
Directional Coronary Atherectomy
(DCA).
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Learning Objectives
Rotablation (PercutaneousTransluminal Rotational
atherectomy or PTRA).
Cutting Balloon.
Transmyocardial Laser
Revascularization (TMLR):.
Coronary Artery BypassGrafting(CABG.
Explain the nursing management.
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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
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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.
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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.
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1- Percutaneous Transluminal
Coronary Angioplasty ( PTCA)
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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.
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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
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Coronary revascularization Cont.Percutaneous Transluminal Coronary
Angioplasty and Stent
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Coronary revascularization Cont.
3- Directional Coronary Atherectomy (DCA)
Atherectomy is a method of treating thelocalized coronary artery narrowing by
shaving or cutting out the blockage.
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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.
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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
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Rotablation
tip spins at high speed to
grind plaque away
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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 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.
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5. Cutting Balloon
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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.
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Coronary revascularization Cont.
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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.
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Coronary Artery Bypass
Grafting(CABG)
Indications
Chronic angina
Unstable anginaAcute myocardial infarction
Acute failure of percutaneous
transluminal coronary angioplasty(PTCA)
Severe coronary artery disease
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Coronary Artery Bypass
Grafting(CABG) Cont.
Most common
arteries
bypassed:
Right coronaryartery
Left anterior
descendingcoronary artery
Circumflex
coronary artery
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Coronary Artery Bypass Grafting(CABG)
Cont.
Conduits Used for Bypass
Saphenous vein used for bypassing
right coronary artery andcircumflex coronary artery
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Coronary Artery Bypass
Grafting(CABG) Cont.
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
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Coronary Artery Bypass
Grafting(CABG) Cont.
Bypass of arteries: Incision in target
artery:
Anastamosis of graftwith artery:
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Coronary Artery Bypass
Grafting(CABG) Cont.
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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.
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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.
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Thank You
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