Surgical treatment of Ischemic Heart Disease

1.  
Hamza J. AlGhamdi

2.  

3. IHD IHD
Surgical management of
complications
Surgical Management
Mitral valve reflux
Post-MI VSD
Acute Coronary
Syndrome
Left ventricular aneurysm

4.  

5.  narrowing or blockage
of the coronary
arteries
 usually caused by
atherosclerosis
 Presents with :
o Stable Angina
o ACS
• Unstable
angina/NSTEMI
• STEMI

6. History
• Symptoms
• Risk factors
• Family Hx
• Medical Hx
• Surgical Hx
• Drug Hx
Examination
Investigation

7. TEE
Angiography Echocardiography
Exercise ECG
ECG

8.  

9. Medical revascularization
PCI CABG OPCAP

10. Medical
As an initial management strategy in patients with stable coronary artery
disease, PCI did not reduce the risk of death, myocardial infarction, or other
major cardiovascular events when added to optimal medical therapy.
COURAGE Trial
N Engl J Med 2007; 356:1503-1516April 12, 2007

12.  Interventional technique
 To relive the stenosis
 Balloon angioplasty , stenting
 Atherectomy
 Mortality <1%

14.  Significant left main artery disease
 Triple vessel disease
 Two vessel disease involving the proximal LAD
 Poor left ventricular function
CABG remains the standard of care for patients with three-vessel or left main
coronary artery disease, since the use of CABG, as compared with PCI,
resulted in lower rates of the combined end point of major adverse cardiac or
cerebrovascular events at 1 year.
Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.-
SYNTAX trial
N Engl J Med. 2009 Mar 5;360(10):961-72. Epub 2009 Feb 18

18.  Preoperative
o MI from stress, anxiety or critical ischemia.
 Intraoperative
o Myocardial failure and lack of adequate myocardial contraction at
the end of bypass
o Embolic infarction
 Postoperative
o Myocardial failure
o Infarction
o Inadequate myocardial protection or excess fluid load.
o Stroke
o Arrhythmias
o Wound
o And other complications of open heart surgery.

19.  

21.  stabilization devices hold
heart in place allowing
operation while
positioning devices allow
the surgeon to lift the
beating heart to access
the lateral and posterior
vessels
 procedure is safe and
well tolerated by most
patients;
however, OPCAB surgery
remains technically more
demanding

22.  OPCAB decreases in-hospital
morbidity (decreased
incidence of chest
infection, inotropic
requirement, supraventricular
arrhythmia), blood product
transfusion, ICU stay, length of
hospitalization, and decreased
CK-MB and troponin I level
 no significant difference in
terms of survival at 2
years, frequency of cardiac
events
(MI, PCI, CHF, recurrent
angina, redo CABG) or
medication usage compared to
on-pump CABG

23.  

24.  Repair of left ventricular aneurysm
 Repair of post infarction VSD
 Acute ischemic MR
 Surgery for ischemic ventricular arrhythmias
 Transplantation
 Ventricular assist devices.

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