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Surgical Therapy of Cardiac Failure

Causes of Low CO Syndrome. Decreased LV preloadHypovolemiaCardiac tamponadePositive-pressure ventilation, PEEPRV dysfunctionTension pneumothorax. Causes of Low CO Syndrome. Decreased contractilityLow EFMyocardial ischemia, stunningHypoxia, hypercapnea, acidosis. Causes of Low CO Syndrome.

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Surgical Therapy of Cardiac Failure

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    1. Surgical Therapy of Cardiac Failure Peter W. Cho, M.D. Division of Cardiac Surgery

    2. Causes of Low CO Syndrome Decreased LV preload Hypovolemia Cardiac tamponade Positive-pressure ventilation, PEEP RV dysfunction Tension pneumothorax

    3. Causes of Low CO Syndrome Decreased contractility Low EF Myocardial ischemia, stunning Hypoxia, hypercapnea, acidosis

    4. Causes of Low CO Syndrome Tachy- and bradyarrhythmias Tachycardia: ? filling time Bradycardia A-fib/flutter: loss of atrial contraction Ventricular arrhythmias

    5. Causes of Low CO Syndrome Increased afterload Vasoconstriction Fluid overload, LV distension LVOT obstruction (struts, leaflets)

    6. Causes of Low CO Syndrome Diastolic dysfunction Syndromes of CV instability, hypotension Sepsis Anaphylactic reaction Adrenal insufficiency Protamine reaction

    7. Assessment of Low CO Syndrome Physical examination Murmurs Breath sounds Peripheral pulses Warmth of extremities

    8. Assessment of Low CO Syndrome Hemodynamic measurements (Swan-Ganz catheter) Measure CO, filling pressures Calculate SVR Measure mixed venous saturation

    9. Assessment of Low CO Syndrome Blood tests Arterial blood gas Hematocrit Serum K+

    10. Assessment of Low CO Syndrome Electrocardiogram Ischemia Arrhythmias Conduction abnormalities

    11. Assessment of Low CO Syndrome Chest radiograph Pneumothorax Hemothorax Position of ETT, IABP

    12. Assessment of Low CO Syndrome Urine output Chest tube drainage

    13. Assessment of Low CO Syndrome Echocardiogram LV systolic, diastolic dysfunction RV systolic dysfunction Cardiac tamponade TTE v. TEE

    14. Treatment of Low CO Syndrome Ensure oxygenation, ventilation Treat ischemia, coronary spasm

    15. Treatment of Low CO Syndrome Optimize preload Stabilize heart rate, rhythm Improve contractility Reduce afterload Maintain blood pressure Correct anemia

    16. Treatment of Right Ventricular Failure Optimize preload: CVP 18-20 mm Hg Confirm AV conduction Maintain adequate systemic perfusion pressure

    17. Treatment of Right Ventricular Failure Lower RV afterload, improve RV contractility Correct hypothermia, hypoxia, hypercapnea, acidosis Inotrope/vasodilators (milrinone, dobutamine, etc.) Pulmonary vasodilator (nesiritide, NO, prostacyclin, etc.) Optimize LV function RVAD as last resort

    18. Hemodynamic Effects of Vaso-active Drugs

    19. Hemodynamic Effects of Vaso-active Drugs

    20. Surgical Therapy Revascularization Valve repair, replacement Ventricular remodeling Cardiomyoplasty

    21. Coronary Artery Bypass

    22. Laser Revascularization (TMR) Clinical Benefits of TMR 1,2: Long-term results show the persistent benefits of TMR and support the conclusion that benefits of having TMR are not placebo A clear majority (over 75%) of patients treated with TMR improved at least 2 angina classes during the first 12 months Long-term results show that the benefit from TMR persists at least 5 years Many patients who undergo TMR have exhibited a reduction in major adverse cardiac events (MACE) Patients often benefit by seeing a reduction in rehospitalization following the TMR procedure There is an increase in event-free survival for many patients Conclusions: TMR has been clinically and scientifically shown to benefit many patients Results of the double-blinded, randomized true sham controlled BELIEF study support that the clinical benefits from myocardial revascularization are real, and not placebo, when utilizing the CardioGenesis System NOTE: This study was performed using PMR. PMR is not FDA approved. Clinical Benefits of TMR 1,2: Long-term results show the persistent benefits of TMR and support the conclusion that benefits of having TMR are not placebo A clear majority (over 75%) of patients treated with TMR improved at least 2 angina classes during the first 12 months Long-term results show that the benefit from TMR persists at least 5 years Many patients who undergo TMR have exhibited a reduction in major adverse cardiac events (MACE) Patients often benefit by seeing a reduction in rehospitalization following the TMR procedure There is an increase in event-free survival for many patients Conclusions: TMR has been clinically and scientifically shown to benefit many patients Results of the double-blinded, randomized true sham controlled BELIEF study support that the clinical benefits from myocardial revascularization are real, and not placebo, when utilizing the CardioGenesis SystemNOTE: This study was performed using PMR. PMR is not FDA approved.

    23. Posterior Band Annuloplasty Repairs can range from procedures as simple as partial annuloplasty...Repairs can range from procedures as simple as partial annuloplasty...

    24. Ring Annuloplasty

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