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Surgical Treatment of Ischaemic Heart Disease

Surgical Treatment of Ischaemic Heart Disease. Division of Cardiothoracic Surgery UWI Mona. Atherosclerosis in native coronary vessels (multi-factorial) Blocks develop Partial blocks prone to platelet clots Large plaques prone to fracture clots form  Myocardial Infarction(MI).

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Surgical Treatment of Ischaemic Heart Disease

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  1. Surgical Treatment of Ischaemic Heart Disease Division of Cardiothoracic Surgery UWI Mona

  2. Atherosclerosis in native coronary vessels (multi-factorial) Blocks develop Partial blocks prone to platelet clots Large plaques prone to fracture clots form  Myocardial Infarction(MI) Coronary Arterial Disease

  3. Unlike MI, angina may be reversible Some form of intervention may alleviate symptoms (open or less-invasive surgery; angioplasty +/- stenting) Angina: Chest Pain due to inadequate Blood Flow  Ischaemia

  4. Coronary Bypass: Bypasses the Block

  5. How is the occlusion bypassed? • Most procedures are done on a non-beating heart • Cardiopulmonary Bypass Machine (CPB) is used to take over the pumping function of the heart, and the gas exchange function of the lungs • Cardioplegia is given to stop the electrical activity of the heart • Therefore, the heart is still, and the delicate operation can be performed with great precision

  6. The Cardiopulmonary Bypass Machine

  7. The CPB Circuitry

  8. The Appearance of the Heart on Opening the Sternum

  9. Anastomosing the Internal Mammary Artery to the Left Anterior Descending Coronary Artery

  10. The Completed LIMA-LAD Anastomosis

  11. Saphenous Vein(green arrow) being anastomosed to Coronary Artery(red arrow)

  12. Completed SV-Coronary Anastomosis

  13. CABG can be done on a BEATING HEART:

  14. What are the results? • Best results are for open surgery using cardiac arrest (30 yrs experience) • Newer techniques such as Beating Heart Surgery, Minimal Access CABG, Robot-assisted CABG, are all in early stages • For multivessel disease, surgery still superior to angioplasty/stenting

  15. Patent LIMA Graft with distally blocked native coronary artery A Late Complication

  16. Angioplasty and Stenting • A catheter-based procedure performed by cardiologists in the CATH LAB which can dilate and maintain the lumen of a partially blocked coronary artery through the insertion of a tiny metallic mesh tube • Very good short-term (< 5 yrs) results, but poor longer term results when compared to traditional surgical therapy

  17. Pre- and Post- Angioplasty

  18. Stent is left inside coronary artery and holds lumen open

  19. Conclusions • CABG is one of the most successful operations ever devised • Hundreds of thousands of procedures worldwide yearly • Surgery has best long-term results, although angioplasty techniques are improving long-term outlooks • All of these interventions are PALLIATIVE THERAPIES, ie. The underlying disease may continue to cause problems post-op

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