OBCAB, MIDCAB, and TAVRs Questions With Complete
Solutions
2 methods of ischemic preconditioning Correct Answer
inhalational agents (via ATP dependent K channels which
hyperpolarize the cells)
elicited by the surgeon occluding and then reperfusing the
coronary
after MIDCAB patients can return to normal activity in...
Correct Answer 2 weeks
benefit of using iso/sevo/des with OBCAB/MIDCAB Correct
Answer preconditioning of heart
benefits of endoscopic MIDCABs over direct access Correct
Answer better visualization of LIMA and no rib spreading
(doesn't use a thoracotomy; uses small incisions for ports)
benefits of high thoracic epidural with OBCAB/MIDCAB
Correct Answer improved analgesia
better pulmonary outcomes
reduction in M&M
offset neurohormonal response to surgery so reduced
hemodynamic instability and reduced myocardial O2 demand
benefits of OBCAB Correct Answer reduced risk of stroke
less anticoagulation needed
avoids morbidity assoc with extracorporeal membrane (SIRS,
platelet activation, fibrinolysis, bleeding, vasodilatory shock)
faster recovery
, lower costs
eliminates risk of aortic manipulation/cross clamp
do MIDCABS use bypass or cardioplegia? Correct Answer can
be done without bypass and cardioplegia, or just without
cardioplegia
explain the hemodynamic instability with OBCAB Correct
Answer heart is lifted/manipulated alot to get to different areas
which reduces SV and arterial BP; also increases CVP and
RVEDP, plus a decreased RVOT flow
can also cause mitral/tricuspid annuli to become distorded (can
cause or worsen regurg)
fast track extubation means extubation within Correct Answer
0-6hr after surgery
goal with OBCAB Correct Answer complete revascularization
(always the goal)
heparin dosing and ACT target for OBCAB/MIDCAB Correct
Answer 150-200units/kg for an ACT>300
important consideration if doing thoracic epidural for
OBCAB/MIDCAB Correct Answer must place epidural day
before or 1hr before heparin administration
(or else risk epidural hematoma)
incision for direct access MIDCAB Correct Answer anterior
left thoracotomy
Solutions
2 methods of ischemic preconditioning Correct Answer
inhalational agents (via ATP dependent K channels which
hyperpolarize the cells)
elicited by the surgeon occluding and then reperfusing the
coronary
after MIDCAB patients can return to normal activity in...
Correct Answer 2 weeks
benefit of using iso/sevo/des with OBCAB/MIDCAB Correct
Answer preconditioning of heart
benefits of endoscopic MIDCABs over direct access Correct
Answer better visualization of LIMA and no rib spreading
(doesn't use a thoracotomy; uses small incisions for ports)
benefits of high thoracic epidural with OBCAB/MIDCAB
Correct Answer improved analgesia
better pulmonary outcomes
reduction in M&M
offset neurohormonal response to surgery so reduced
hemodynamic instability and reduced myocardial O2 demand
benefits of OBCAB Correct Answer reduced risk of stroke
less anticoagulation needed
avoids morbidity assoc with extracorporeal membrane (SIRS,
platelet activation, fibrinolysis, bleeding, vasodilatory shock)
faster recovery
, lower costs
eliminates risk of aortic manipulation/cross clamp
do MIDCABS use bypass or cardioplegia? Correct Answer can
be done without bypass and cardioplegia, or just without
cardioplegia
explain the hemodynamic instability with OBCAB Correct
Answer heart is lifted/manipulated alot to get to different areas
which reduces SV and arterial BP; also increases CVP and
RVEDP, plus a decreased RVOT flow
can also cause mitral/tricuspid annuli to become distorded (can
cause or worsen regurg)
fast track extubation means extubation within Correct Answer
0-6hr after surgery
goal with OBCAB Correct Answer complete revascularization
(always the goal)
heparin dosing and ACT target for OBCAB/MIDCAB Correct
Answer 150-200units/kg for an ACT>300
important consideration if doing thoracic epidural for
OBCAB/MIDCAB Correct Answer must place epidural day
before or 1hr before heparin administration
(or else risk epidural hematoma)
incision for direct access MIDCAB Correct Answer anterior
left thoracotomy
