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OVERVIEW
Common disorders requiring cardiac surgery:
- coronary artery disease
- aortic valve disease
- mitral valve disease
CORONARY ARTERY DISEASE
General – based on:
(1) symptoms
(2) left ventricular function (improves post surgery if reduced)
(3) area of ischaemia
(4) anatomic localisation of coronary artery stenosis
Specific Lesions
(1) left main stem > 50% stenosis
(2) proximal LAD or proximal LCx > 70%
(3) triple vessel disease with >70% stenosis in all 3 coronary territories
(4) 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)
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
References and Links
- Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clinic proceedings. 85(5):483-500. 2010. [pubmed] [free full text]
- Nishimura RA, Otto CM, Bonow RO. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 63(22):e57-185. 2014. [pubmed] [free full text]
- Vahanian A, Alfieri O, Andreotti F. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 42(4):S1-44. 2012. [pubmed] [free full text]
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