冠状动脉搭桥术CABG课件.ppt

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1、CoronaryArteryBypassGrafting1Definition Indication ContraindicationCABG Types Graft chooseComplications2医者仁心 一路相随 WithYouAllTheWayWhatisCABG?pCoronaryarterybypassgraftsurgery(CABG)isaprocedurethatusespatients own veins(usuallyfromthelegs)orarteriestobypassnarrowedareasandrestorebloodflowtoheartmuscl

2、e.pBypasssurgerycanmarkedlyreduceorrelieve chest pain formostpatients,andimprove survival andminimizecomplicationsofcardiacischemiapMorethan300,000 patientsundergoCABGsurgeryannuallyintheUS3医者仁心 一路相随 WithYouAllTheWayCoronary Arteries4医者仁心 一路相随 WithYouAllTheWayAHAGuidelineforCABGSurgeryLeftmaincorona

3、ryarterydisease(LMCA)orsignificantdiseaseoftheLADwithanothervesselinvolvedorallthreecoronaryarteries(LAD,LCXandRCA).DiffusediseasenotsuitabletotreatmentwithaPCIorstentplacementisnotsuccessfulinopeningtheblockedbloodvesselsSurvivorsofsuddendeathwhohavecoronaryarterydiseaseOtherhigh-riskpatientssuchas

4、thosewithsevereventriculardysfunction(i.e.lowejectionfraction),ordiabetesmellitus.CABGissuperiortoPCIforsomepatientswithmultivesselCAD医者仁心 一路相随 WithYouAllTheWayCABGisnotrecommendedforpatientswhodonothaveadequatenativevesselstouseasgraft.Patientswithverysmallcoronaryarteries(1mmor1.5mm)andatheroscler

5、osisoftheaorta,heavilycalcified,orlocatedwithintheheartmuscleratherthanonthesurfacearechallengesinCABG.CABGContraindication医者仁心 一路相随 WithYouAllTheWayCABGTraditionalCABGNontraditionalCABGOffPumpCoronaryArteryBypassGraftingMinimallyInvasiveDirectCoronaryArteryBypassGraftingTypesofCABG医者仁心 一路相随 WithYou

6、AllTheWayOffPumpCoronaryArteryBypassGrafting医者仁心 一路相随 WithYouAllTheWayOff Pump Coronary Artery Bypass GraftingAdvantages:AdecreasedneedforbloodtransfusionLessmyocardialenzymereleaseLessrenaldysfunctionLessearlyneurologicaldysfunctionDisadvantage:Decreasedgraftpatencyduetoproblemswithanastomoses9医者仁心

7、 一路相随 WithYouAllTheWayChoiceofGraftInternalthoracicarteries(alsocalledinternalmammaryarteries)RadialarteriesSaphenousveinsRightgastroepiploicartery医者仁心 一路相随 WithYouAllTheWaylSaphenousveingraftpatencydeclinessignificantlystartingatthetimeofsurgery.Ratesbelow90percentarecommonatoneyear.lLong-termgraft

8、patencyisexcellentwithinternal thoracic artery andradial artery bypassgrafts.Ratesexceeding90percentat5to10yearsarecommon.lGraftpatencyisdependentonanumberoffactors,includingthetypeofgraftused,thesizeofthecoronaryarterythatthegraftisanastomosedwith,andtheskillofthesurgeon(s)performingtheprocedure.Bl

9、oodflowbeginstodiminishwitharounda70percentstenosisinthegraft.医者仁心 一路相随 WithYouAllTheWayBleedingthatmayrequireareturntotheoperatingroomHeartattackorheartfailureorarrhythmiaStrokeorchangesincognitivefunctionPulmonaryproblems;WoundinfectionRenalfailure;Death.BypassSurgeryComplications医者仁心 一路相随 WithYou

10、AllTheWayCardiaccomplicationsAtrialfibrillation：40%Sustainedventriculartachycardiaorventricularfibrillation:2to3%Postoperativebradycardia：0.8to4%PericarditisorCardiactamponadeBypassComplications:Cardiaccomplications医者仁心 一路相随 WithYouAllTheWayApproximately30%ofpatientsrequireabloodtransfusionafterCABG

11、.Onlyabout2percentofpeoplerequiresurgerytostopexcessivebleeding.Medicationshoulddiscontinuedpriortosurgery:Aspirin:2-3daysPlavix:5-7daysTirofiban:4to6hoursWarfarin:FourdaysUnfractionatedHeparin:D/CatthetimeofsurgeryLowmolecularweightheparin12to24hourspriortosurgeryBypassSurgeryComplications:Bleeding

12、医者仁心 一路相随 WithYouAllTheWayStrokeorDepressionPost-opdeliriumShort-andlong-termcognitivechangesBypassComplications:NeurologiccomplicationsTheincidenceofneurologicproblemsfollowingCABG:2 to 4%Olderpatientsandwomenareaffectedmorefrequently.医者仁心 一路相随 WithYouAllTheWaySternal wound infection:1%.Itusuallyde

13、velopsbyseventoninedaysaftersurgery.Leg wounds infection:5%,dermatitis,cellulitis,nervedamage,andnon-healingulcers;mostareminoranddonotrequiresurgicalintervention.Catheter related infection:CVC,Swan-ganzcatheter,A-line,Endotrachealtube,FoleycatheterBypassComplications:Infection医者仁心 一路相随 WithYouAllTh

14、eWayRenalfailureAtemporarydecreaseinkidneyfunctionoccursinapproximately5to10%.Pleuraleffusions:occurringinupto90%.Theyareusuallysmallanddonotrequiretreatment.Phrenicnervedamage:Numbness,tenderness,orburningdiscomfortoverthesternumandleftanterolateralchestwall.Painusuallysubsidesbyfourmonths.AorticdissectionThrombocytopeniaOthercomplications医者仁心 一路相随 WithYouAllTheWay