©2014Cengage
Delmar, Cengage
Rights Reserved.
May
not be scanned,
©2014 Delmar,
Learning.Learning.
All RightsAll
Reserved.
May not be
scanned,
copied, copied,
duplicated,
to aaccessible
publicly accessible
website,
in in
whole
duplicated,
or postedor
toposted
a publicly
website, in
whole or
part.or in part.
1
CHAPTER 22
Cardiothoracic Surgery
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
2
Objectives
• After studying this chapter, you will be able
to:
– Recognize the relevant anatomy of the
cardiovascular and respiratory systems
– Summarize the pathology that prompts
cardiac or thoracic surgical intervention and
the related terminology
– Determine any special preoperative
diagnostic procedures/tests for the patient
undergoing cardiac or thoracic surgery
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
3
Objectives (cont’d.)
– Determine any preoperative preparation
procedures
– Indicate the names and uses of
cardiovascular and thoracic equipment,
instruments, and supplies
– Summarize the surgical steps of the cardiac
and thoracic procedures
– Interpret the purpose and expected outcomes
of the cardiac and thoracic procedures
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
4
Objectives (cont’d.)
– Recognize the immediate postoperative care
and possible complications of the cardiac and
thoracic procedures
– Assess any specific variations related to the
preoperative, intraoperative, and
postoperative care of the patient undergoing a
cardiac or thoracic procedure
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
5
Part I: Thoracic Surgical
Procedures
• Introduction
– Thoracic surgical procedures
• Primary focus is the lungs
• Includes treatment of chest wall deformities and
identification of lesions within the mediastinum
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
6
Diagnostic Procedures and Tests
• Imaging studies used in diagnosis of
thoracic diseases and disorders
– Standard X-rays
• Anteroposterior (AP) and lateral
– CT scanning and MRI
• Useful for evaluation of pericardial and intracardiac
masses
– Pulmonary angiography
• Primarily used to detect pulmonary embolism and
other blockages
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
7
Diagnostic Procedures and Tests
(cont’d.)
• Other useful diagnostic procedures for the
evaluation of cardiac disease
– Electrocardiography
– Echocardiography
– Cardiac catheterization
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
8
Instrumentation, Routine
Equipment and Supplies
• Instrumentation
– Thoracic procedures: instruments needed to
remove a rib (e.g., Bethune rib shears and
Matson rib stripper/elevator) and expose and
repair the organs of the thorax
– Thoracotomy: vascular instrument set and
thoracotomy instrument set
• Refer to Tables 22-1 and 22-2
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
9
Instrumentation, Routine
Equipment and Supplies (cont’d.)
• Anesthesia monitoring equipment
– Swan-Ganz and arterial catheters
– Electrocardiography equipment
– Oxygen saturation equipment
– Temperature equipment
– Blood pressure equipment
– Double-lumen endotracheal tube
• Supplies
– Refer to text for a list of routine supplies
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
10
Thoracic Surgical Procedures
• Include:
– Bronchoscopy
– Mediastinoscopy
– Video-assisted thoracic surgery (VATS)
– Nuss pectus excavatum repair by VATS
– Pulmonary thromboendarterectomy
– Decortication of the lung
– Upper lobectomy
– Pneumonectomy
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
11
Part II: Adult Cardiac Surgical
Procedures
• Introduction
– Cardiac surgery is typically performed in the
largest room of the OR suite
• Must accommodate a larger number of OR
personnel and equipment
– Cardiac patient may come from the cardiac
care unit on an ICU bed with monitoring lines
in place
• Occasionally, the patient will be brought over from
the cardiac catheterization lab
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
12
Diagnostic Procedures and Tests
• Useful diagnostic procedures for the
evaluation of cardiac disease
– Chest X-ray
– CT scan and MRI
– Electrocardiography
– Echocardiography
– Electrophysiology studies
– Cardiac catheterization
– Arteriograms
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
13
Routine Instrumentation,
Equipment, and Supplies
• Most cardiac procedures require the same
instrumentation, equipment, and supplies
– Specialty items are added that are unique to
the procedure
• Instrumentation
– Cardiac instrument set: refer to Table 22-3
• Equipment
– Refer to text for a list of routine equipment
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
14
Anatomy and Physiology of the
Heart
• Role of the heart within the cardiovascular
system
– Essential for blood circulation
• Carries waste substances away from cells to
excretory organs for elimination
• Brings vital nutrients and oxygen from the
respiratory and digestive organs to cells
throughout the body
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
15
Anatomy and Physiology of the
Heart (cont’d.)
• Location of the heart
– Refer to Figure 22-15
• Coverings of the heart
– Refer to Figure 22-16
• The heart wall: layers
– Epicardium, myocardium, and endocardium
• The heart chambers
– Two atria and two ventricles
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
16
Anatomy and Physiology of the
Heart (cont’d.)
• The heart valves
– Atrioventricular valve
– Tricuspid valve
– Pulmonary semilunar valve
– Mitral valve
– Aortic semilunar valve
– Chordae tendineae
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
17
Anatomy and Physiology of the
Heart (cont’d.)
• Blood flow through the heart and blood
supply for the heart
– Refer to text for detailed description
• Cardiac conduction
– Cardiac conduction system coordinates the
events of the cardiac cycle
• Specialized areas of tissue transmit electrical
impulses throughout the myocardium for the
rhythmical activity of the heart
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
18
Anatomy and Physiology of the
Heart (cont’d.)
• Techniques of cardiopulmonary bypass:
refer to Figures 22-17 through 22-20
– Aortic cannulation
– Venous cannulation
– Left ventricular vent placement via the left
atrium
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
19
Adult Cardiac Surgical Procedures
• Include:
– Coronary artery bypass with grafting (CABG)
– MID-CABG
– OPCAB
– Intra-aortic balloon pump (IABP)
– Ventricular assist device (VAD) insertion
– Orthotopic heart transplant
– Ventricular aneurysm repair
– Aortic valve replacement
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
20
Mitral Valve Replacement
• Procedure is similar to aortic valve
replacement
– Decision to replace the mitral valve depends
on the severity of symptoms
• Graded by New York Heart Association method
• Mitral valve can be either repaired or
replaced
– Refer to text and Figures 22-32 and 22-33
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
21
Mitral Valve Replacement (cont’d.)
• Technique
– Replacement of the mitral valve with a
prosthesis
– Refer to text and Figure 22-34
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
22
Part III: Pediatric Cardiac
Procedures
• Introduction
– Surgical procedures for repair of congenital
heart defects
• Repair of atrial septal defect (ASD) and ventricular
septal defect (VSD)
• Closure of patent ductus arteriosus (PDA)
• Repair of coarctation of the aorta
• Repair of tetralogy of Fallot (TOF)
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
23
Part III: Pediatric Cardiac
Procedures (cont’d.)
• Preoperative preparation
– Pediatric cardiac instruments are smaller and
more delicate
– Pediatric patients are at greater risk of
hypothermia, therefore, OR temperature is
generally raised
– Blood loss should be closely monitored by the
surgical team because of the pediatric
patient’s low blood volume
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
24
Pediatric Cardiac Procedures
• Include:
– Repair of ASD
– Closure of patent ductus arteriosus (PDA)
– Repair of coarctation of the aorta
– Repair of TOF
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
25
Summary
• This chapter reviewed:
– Anatomy of the cardiovascular and respiratory
systems
– The pathology that prompts cardiac or
thoracic surgical intervention
– Diagnostic procedures and tests
– Cardiovascular and thoracic equipment,
instruments, and supplies
– Cardiac and thoracic surgical procedures
©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,
duplicated, or posted to a publicly accessible website, in whole or in part.
26