Surgical Intervention for Coronary Artery Diseases

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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 (Percutaneous Transluminal Rotational
  atherectomy or PTRA).
• Cutting Balloon.
• Transmyocardial Laser Revascularization (TMLR).
• Coronary Artery Bypass Grafting(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. Candidates for revascularization include
  those with evidence of continuing extensive
  ischaemia or symptoms that persist despite
  optimal medical therapy

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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.

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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.
•  

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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 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.

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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 the localized
  coronary artery narrowing by shaving or cutting
  out the blockage.

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• 4. Rotablation (Percutaneous Transluminal
  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 the coronary 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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Rotablationtip 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 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.

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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 deprived
  areas 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 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.

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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

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Coronary Artery Bypass Grafting(CABG) Cont.

• Most common arteries bypassed
• Right coronary artery
• Left anterior descending coronary 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 and circumflex coronary artery

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Coronary Artery Bypass Grafting(CABG) Cont.

• Internal mammary artery (IMA) used for bypassing
  left anterior descending coronary artery
• Patency rate over 90 after 10 years
• If more veins are needed, alternative sites such
  as upper extremity veins can 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 graft with artery

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Coronary Artery Bypass Grafting(CABG) Cont.
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Coronary Artery Bypass Grafting(CABG) Cont.
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Nursing Management

• Preoperative
• Obtain the clients 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.

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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.

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Nursing Management Cont.

• Assess the clients fluid status frequently
  during immediate postoperative period.
• Note the clients level of consciousness,
  neurologic status, ability to move.
• To prevent infection during changing a clients
  dressing , the nurse should observe careful hand
  washing procedures.

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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.

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• Thank You