Indications for Adult Cardiac Surgery
20/4/11
PY Mindmaps
CORONARY ARTERY DISEASE
General
- based on:
(1)
(2)
(3)
(4)
symptoms
left ventricular function (improves post surgery if reduced)
area of ischaemia
anatomic localisation of coronary artery stenosis
Specific Lesions
(1)
(2)
(3)
(4)
left main stem > 50% stenosis
proximal LAD or proximal LCx > 70%
triple vessel disease with >70% stenosis in all 3 coronary territories
significant proximal LAD stenosis with 2 vessel disease
Trials
- early 1990’s
- three large MRCT comparing CABG vs medical treatment -> all showed benefit
- important differences in current practice: patients < 65 years, no arterial grafts, newer
medical therapies (statins) not available which have been shown to prolong life after CABG.
Risk Predictors (can use Euroscore)
-
age
DM
COPD
renal failure
previous surgery
left ventricular dysfunction
pulmonary hypertension
emergency operation
AORTIC VALVE
Aortic stenosis
- symptomatic
- valve area (severe < 1cm2)
Jeremy Fernando (2011)
Aortic regurgitation
-
NYHA class III or IV symptoms due to AR
LVEF <25% or end systolic dimension >60mm or both
LVEF 25-50% (controversial)
AR with root dilatation
MITRAL VALVE
Mitral stenosis
- valve area (severe < 1.5cm2) and symptomatic (NYHA III or IV)
Mitral regurgitation
- symptomatic
- asymptomatic patients with LV dysfunction
- acute AF due to MR
Jeremy Fernando (2011)