Cardiac Transplant

8/6/2019 Cardiac Transplant

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CARDIACSURGERIES

:Prepared by:Prepared by

. .Mrs Theresa Margarita Marivee L Saldevar. .Mrs Theresa Margarita Marivee L Saldevar


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BRIEF HISTORY

1801 - Francisco Romero is credited with thefirst attempted cardiac surgery. Romerounsuccessfully attempted to perform an openpericardiostomy

4th of September 1895 - The German doctorLudwig Wilhelm Carl Rehn (1849 to 1930) iscredited with performing the first successfulheart surgery that involved sutures.

December of 1967 - Dr. Christiaan Barnard, asurgeon from South Africa, completed thefirst successful heart transplant.


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SURGICAL APPROACHES

Open Heart Surgery

Modified Partial Sternotomy

Surgeries with Smaller Incisions orMinimally Invasive Heart Surgery


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TRADITIONAL FULL STERNOTOMY

involves making an incision in themiddle of the chest from thetop of the sternum to thebottom

the entire rib cage is opened andthe heart muscle is fullyexposed

The patient is placed on heart-

lung bypass which allowsoxygenated blood to circulateto the body while it bypassesthe heart


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TRADITIONAL FULL STERNOTOMY

Advantages: The benefit of a full sternotomy is fullexposure.

Disadvantages: The disadvantages are a longerrecovery period for the patient and significantmusculo-skeletal discomfort. There is also higherrisk of stroke, kidney damage and bleeding when apatient is placed on a heart-lung bypass machine.


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FULL STERNOTOMY BUT WITH AN "OFF BYPASS"

the patient will still experience the samemusculo-skeletal insult, he/she will notbe placed on the heart lung machine

the surgeon performs the bypass on a

beating heart utilizing a stabilizinginstrument


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Indication: The "off bypass" approach is recommendedfor patients with a highly calcified aorta. Placing apatient with highly calcified lesions onto bypassinvolves passing cannulae through vessels.


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Contraindication: "Off bypass" is notrecommended for a patient with a weakened heartmuscle. As mentioned above, this approach placesstress on the heart and is, therefore, not well tolerated

by this group of patients. Since the operation is doneon a beating heart, patients requiring valve repair orreplacement are not candidates for this procedure.


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MODIFIED PARTIAL STERNOTOMY

A partial sternotomy can beperformed when limited exposure isadequate.

Indications:

1. Used for valve surgery (done with amidline incision ofapproximately four inches inlength with disruption of only

about half of the sternum)2. Can also be done for coronary

surgery (the incision begins atthe bottom of the chest boneand stops at the third rib)


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This approach offers many benefits overtraditional heart surgery. These include:

Smaller incisions with little scarring

Less pain

Minimal blood loss and less need fortransfusion

Greatly reduced risk for infection

Faster return to normal activities

Shorter hospital stay


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Heart surgeries that may be done using minimally invasive techniquesinclude:

Coronary bypass surgery possible when only one or two bypassgrafts is needed

ASD/PFO closure a technique to close a hole in the septum (wall)between the atria, the two upper chambers of the heart. The hole an atrial septal defect (ASD) or a patent foramen ovale (PFO) is acongenital defect.

Atrial fibrillation (arrhythmia) ablation to correct an abnormal heartrhythm

Mitral valve surgery to repair or replace the mitral valve Aortic valve surgery to repair or replace the aortic valve


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Types of Minimally Invasive Heart Surgery:

Minimally Invasive Direct CoronaryArtery Bypass (MIDCAB)

Portal Access Surgery

Robotic-Assisted Heart Surgery


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Minimally Invasive Direct Coronary ArteryBypass (MIDCAB)

It involves a small incision usually onthe left anterior portion of the chestwall between the third and fourth orfourth and fifth rib

This surgery is usually reserved forpatients with single or double vesseldisease with the blocked vesselsbeing located on the anterior portionof the heart as these vessels aremore easily accessed by the surgeon


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Portal Access Surgery

is a method of surgery consisting of catheters and cannulaethat allows the surgeon to put the patient on bypass.

The heart is stopped and your blood is pumped through anoxygenator or "heart-lung" machine to receive oxygen

during the surgery. This is called "cardiopulmonarybypass." Then several small holes or "ports" are made inyour chest. The surgical team passes instrumentsthrough the ports to perform the bypasses, with orwithout another small chest incision. The cardiac surgeonviews these operations on video monitors rather thandirectly.


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Robotic-Assisted Heart Surgery

One type of minimally invasiveheart surgery that's still beingdeveloped is robotic-assistedsurgery. For this surgery, a

surgeon uses a computer tocontrol surgical tools on thinrobotic arms.

The tools are inserted throughsmall incisions in the chest.This allows the surgeon to docomplex and highly precisesurgery. The surgeon always isin total control of the robotic

arms; they don't move on theirown.


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TYPES OFCARDIAC SURGERY

Coronary artery bypass grafting

Valve surgery

Vascular surgery

Arrhythmia (atrialfibrillation) surgery

Heart transplant surgery
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CORONARY ARTERY BYPASS GRAFTING

During CABG, a surgeon takes avein or an artery from yourchest, leg or another part of yourbody and connects, or grafts, it

to the blocked artery. Thegrafted artery bypasses theblockage

Indications:patients with severeangina from atherosclerosis andothers with CAD who have a riskof MI


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CARDIAC VALVE SURGERY

Heart valve surgery is used to repair or replacediseased heart valves.


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Types of Valve Surgery:

Open surgery

Minimally invasive valve surgery

1.LaparoscopyLaparoscopy orendoscopyendoscopy

2.Percutaneous surgery (through the skin)

3.Robot-assisted surgery
http://www.nlm.nih.gov/medlineplus/ency/article/007016.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003338.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007339.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007339.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003338.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007016.htm


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Types of Valve Surgery:

Ring annuloplasty -- The surgeon repairsthe ring-like part around the valve bysewing a ring of metal, cloth, or tissuearound the valve.

Valve repair -- The surgeon trims, shapes,or rebuilds one or more of the leaflets ofthe valve. The leaflets are flaps thatopen and close the valve.


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Two main types of new valves:

Mechanical -- made of man-madematerials, such as cloth, metal(stainless steel or titanium), orceramic.

Biological -- made of human oranimal tissue. These valveslast 12 - 15 years


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Heart valve problems treated with surgery:

Aortic insufficiency

Aortic stenosis

Mitral regurgitation

Mitral stenosis

Mitral valve prolapse

Pulmonary valve stenosis

Tricuspid regurgitation
http://www.nlm.nih.gov/medlineplus/ency/article/000179.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000178.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000176.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000175.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000180.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001096.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000169.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000169.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001096.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001096.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000180.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000180.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000175.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000175.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000176.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000178.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000178.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000179.htm


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VASCULAR SURGERY

is a specialty of surgery in which diseasesof the vascular system, orarteries andveins, are managed by medical therapy,minimally-invasive catheter procedures,

and surgical reconstruction
http://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Artery


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VASCULAR SURGERY

Indications:

Arterial diseases: Aneurysms, Ischemia,peripheral artery occlusive disease,Diabetic foot ulcers

Venous diseases: Deep Vein Thrombosis,Thrombophlebitis, Varicose Veins andVaricosities, Venous malformations

Medical disorders with a significant

vascular components, for example:Raynaud's syndrome, Scleroderma,Hyperhidrosis
http://en.wikipedia.org/wiki/Aneurysmhttp://en.wikipedia.org/wiki/Ischemiahttp://en.wikipedia.org/wiki/Peripheral_artery_occlusive_diseasehttp://en.wikipedia.org/wiki/Deep_Vein_Thrombosishttp://en.wikipedia.org/wiki/Thrombophlebitishttp://en.wikipedia.org/wiki/Varicose_Veinshttp://en.wikipedia.org/wiki/Varicositieshttp://en.wikipedia.org/wiki/Venous_malformationhttp://en.wikipedia.org/wiki/Raynaud%27s_syndromehttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Hyperhidrosishttp://en.wikipedia.org/wiki/Hyperhidrosishttp://en.wikipedia.org/wiki/Sclerodermahttp://en.wikipedia.org/wiki/Raynaud%27s_syndromehttp://en.wikipedia.org/wiki/Raynaud%27s_syndromehttp://en.wikipedia.org/wiki/Venous_malformationhttp://en.wikipedia.org/wiki/Varicositieshttp://en.wikipedia.org/wiki/Varicose_Veinshttp://en.wikipedia.org/wiki/Thrombophlebitishttp://en.wikipedia.org/wiki/Deep_Vein_Thrombosishttp://en.wikipedia.org/wiki/Peripheral_artery_occlusive_diseasehttp://en.wikipedia.org/wiki/Ischemiahttp://en.wikipedia.org/wiki/Aneurysm


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VASCULAR SURGERY

Types: Aneurysm resection - aneurysm will be removed and the damaged

portion of your blood vessel will be replaced with a man-made graft

Grafting of aneurysm - Some aortic aneurysms can be repaired withouttraditional surgery, using endovascular aortic repair. A tube called astent graft is inserted through an artery in the groin. The stent graftmakes a bridge between the healthy parts of the aorta (above andbelow the aneurysm).
http://www.webmd.com/hw-popup/grafthttp://www.webmd.com/hw-popup/graft


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VASCULAR SURGERY

Types:

Embolectomy - is the emergency surgicalremoval ofemboli which are blockingblood circulation

Endarterectomy - is a surgical procedureto remove the atheromatousplaquematerial, or blockage, in the lining of anartery constricted by the buildup ofsoft/hardening deposits. It is carried outby separating the plaque from thearterial wall
http://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Embolushttp://en.wikipedia.org/wiki/Surgical_procedurehttp://en.wikipedia.org/wiki/Atheromahttp://en.wikipedia.org/wiki/Atheromahttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Atheromahttp://en.wikipedia.org/wiki/Atheromahttp://en.wikipedia.org/wiki/Atheromahttp://en.wikipedia.org/wiki/Surgical_procedurehttp://en.wikipedia.org/wiki/Embolushttp://en.wikipedia.org/wiki/Surgery


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ARRHYTHMIA SURGERY

An arrhythmia is a problemwith the rate or rhythm ofthe heartbeat.

Types of Surgery:

1.Pacemaker

2.ImplantableCardioverter

Defibrillator3.Maze Surgery
http://www.nhlbi.nih.gov/health/dci/Diseases/arr/arr_whatis.htmlhttp://www.nhlbi.nih.gov/health/dci/Diseases/arr/arr_whatis.html


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PACEMAKER

A pacemakeris asmall device that's placedunder the skin of your chestor abdomen. Wires connect

the pacemaker to your heartchambers. The pacemakersends electrical signalsthrough the wires to controlyour heart rhythm.


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Implantable Cardioverter Defibrillator

An ImplantableCardioverter Defibrillatoris another small devicethat's placed in your chest

or abdomen. This devicealso is connected to yourheart with wires. An ICDchecks your heartbeat fordangerous arrhythmias. If it

senses one, it sends anelectric shock to your heartto restore a normal heartrhythm.


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MAZE SURGERY

During the surgery, the surgeon makes a number ofsmall incisions in both of the heart's upper chambers. Tomake the incisions, surgeons can use a sharp surgicalknife called a scalpel, a cryoablation device that destroys

tissue by freezing it, or a radiofrequency device thatdestroys tissue using radiofrequency energy (likemicrowave heat). Some surgeons use a combination oftechniques to make the incisions. The incisions are madein a certain pattern, like a maze, that will direct the heart's

electrical impulses straight to the heart's lower chambers.


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CARDIAC TRANSPLANT

Hearts transplants, orcardiac transplantation, is a surgical transplantprocedure performed on patients with end-stage heart failure orsevere coronary artery disease.

The most common procedure is to take a working heart from a recentlydeceased organ donor(allograft) and implant it into the patient.

The patient's own heart may either be removed (orthotopic procedure)or, less commonly, left in to support the donor heart (heterotopicprocedure)
http://en.wikipedia.org/wiki/Organ_transplanthttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Coronary_artery_diseasehttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Organ_donorhttp://en.wikipedia.org/wiki/Allografthttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Heart_transplantationhttp://en.wikipedia.org/wiki/Allografthttp://en.wikipedia.org/wiki/Organ_donorhttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Coronary_artery_diseasehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Organ_transplant


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Contraindications of Heart Transplant:

Kidney, lung, orliverdisease

Insulin-dependent diabetes with otherorgan dysfunction

Life-threatening diseases unrelated to

heart failure Vascular disease of the neck and leg

arteries.

High pulmonary vascular resistance

Recent thromboembolism Age over 60 years

Alcohol, tobacco or drug abuse
http://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Vascular_diseasehttp://en.wikipedia.org/wiki/Vascular_diseasehttp://en.wikipedia.org/wiki/Heart_failurehttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Kidney


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PROCEDURE - Preoperative

Typical heart transplantation begins with asuitable donor heart being located froma recently deceased orbrain deaddonor, also called a

beating heart cadaver. The heart is removed from the donor and

inspected by a team of surgeons to seeif it is in a suitable condition to betransplanted.

The patient must also undergo manyemotional, psychological, and physicaltests to make sure that they are in goodmental health and will make good use of

their new heart.
http://en.wikipedia.org/wiki/Deceasedhttp://en.wikipedia.org/wiki/Brain_deathhttp://en.wikipedia.org/wiki/Beating_heart_cadaverhttp://en.wikipedia.org/wiki/Beating_heart_cadaverhttp://en.wikipedia.org/wiki/Brain_deathhttp://en.wikipedia.org/wiki/Deceased


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PROCEDURE - Operative

the patient is taken into the operating room and given ageneral anesthetic

Either an orthotopic or a heterotopic procedure is followed
http://en.wikipedia.org/wiki/Operating_roomhttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/General_anesthetichttp://en.wikipedia.org/wiki/Operating_room


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PROCEDURE - Post-operative

The patient is taken into ICU to recover

When they wake up, they will betransferred to a special recovery unit inorder to be rehabilitated

Once the patient is released, they will haveto return to the hospital for regularcheck-ups and rehabilitation sessions

The patient will have to remain on lifetime

immunosuppressant medication to avoidthe possibility ofrejection
http://en.wikipedia.org/wiki/Intensive_care_unithttp://en.wikipedia.org/wiki/Physical_medicine_and_rehabilitationhttp://en.wikipedia.org/wiki/Immunosuppressanthttp://en.wikipedia.org/wiki/Transplant_rejectionhttp://en.wikipedia.org/wiki/Transplant_rejectionhttp://en.wikipedia.org/wiki/Immunosuppressanthttp://en.wikipedia.org/wiki/Physical_medicine_and_rehabilitationhttp://en.wikipedia.org/wiki/Intensive_care_unit


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NURSING CARE FORCARDIAC SURGERIES

Patient Preparation

Monitoring and Aftercare

Home Care Instructions


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Patient Preparation

Perform and document extensive assessment

Reinforce the doctors explanation of the surgeryfor the patient

Restrict food and fluids after midnight

Provide pre-operative medications


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Monitoring and Aftercare

The top priority is to keep him hemodynamically stable so his vitalorgans are adequately perfused

Assess cardiopulmonary function

Provide analgesia and non-pharmacologic methods of relieving pain.Administer I.V. push opioids in the immediate postoperative period,

then switch to oral forms by the second or third postoperative day Monitor post-operative complications, such as stroke, pulmonary

embolism, pneumonia and impaired renal function.

Gradually allow the patient to increase activities, as ordered

Monitor the incision site for signs of infection or drainage

Provide emotional support


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Home Care Instructions

Watch for and immediately notify the doctor for any signs of infection orpossible arterial reocclusion

Call the doctor in case of weight gain greater than 3 lb in 1 week

Follow the prescribed diet low sodium and cholesterol

Maintain a balance between activity and rest

Follow exercise program

Follow lifestyle modification

Perform coughing and deep breathing exercises

Make sure the patient understands the prescribed medications

Avoid certain things for eight to 12 weeks to reduce the risk of openingthe incision

Documents

Cardiac Transplant