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Cardiac Surgery

Transcript: How has it affected society? Innovative doctors from WWII onward, aided by advances such as the heart-lung machine and immuno-suppressant drugs! Thank You! By Erika Martinez Harken began operating on animals, trying to develop a technique that would allow him to cut into the wall of a still beating heart, insert a finger, locate the shrapnel and remove it. 1.Abnormal heart rhythms 2. No cures/treatment 3. Death On this date in 1893, the first successful American open-heart surgery was performed by a Black surgeon, Dr. Daniel Hale Williams. Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart What is/ was the ailment? Who entity is credited with the advancment? Both Publicly and privately funded What are the symptoms and or problems? Many of Harken's patients were young soldiers evacuated from the European front with shell fragments and bullets lodged inside their hearts. Dr. Dwight Harken used Cardiac surgery in World war 2 Cardiac Surgery during WWll What is Cardiac Surgery? Publicly or privately funded? How was it treated before WW2 A variety of surgeons researched on cardiac surgery. 1. sutures ( were not effective ) 2.body temperature was reduced by immersion into a tub of ice water contained in a watering tank designed for a horse farm so the patient could survive longer without a pumping heart Who was researching it? What is the advancement? 1.heart attack or stroke. 2.irregular heartbeat. 3.lung or kidney failure. 4.chest pain and low fever. 5.memory loss or “fuzziness” 6.blood clot. 7.blood loss. It has improved patients well being, reduced their pain and has saved their life! What other research has it led to? Another type of research that it has led to is brain surgery because they thought if the heart can be touched so can the brain, 62 ECG bpm

Cardiac Surgery

Transcript: Cardiac surgery is still at its infancy, due to the fact that open heart surgery has only been around for about 50 years. With cardiopulmonary bypass, there have been many accomplishments with surgeries, unlike in the 1950’s. Everyday, very serious surgeons are trying to invent new ways to make cardiovascular surgery simpler and easier without putting the patient at much risk. The future of this specialty is bright; saving lives in the most miraculous way is what is going to keep this “fraternity” alive for a very long time. "Daniel Hale Williams." Bio. A&E Television Networks, 2015. Web. 29 Apr. 2015. Richardson, Robert G. "Heart Surgery." Encyclopedia Britannica Online. Encyclopedia Britannica, n.d. Web. 29 Apr. 2015. "What Is Heart Surgery?" National Heart, Lung, and Blood Institute. N.p., 8 Nov. 2013. Web. 30 Apr. 2015. Verrier, Edward D., M. D. "THE FUTURE OF CARDIOTHORACIC SURGERY... DYING STAR OR SUPERNOVA?" American Association for Thoracic Surgery. N.p., n.d. Web. 30 Apr. 2015. My American Heart. American Heart Association, n.d. Web. 30 Apr. 2015. Thank You! Influences regarding cardiac surgery By: Daniela Diaz Heart surgery is done to correct problems with the heart. Many heart surgeries are done each year in the United States for various heart problems. Heart surgery is used for both children and adults. Doctors also use heart surgery to: Repair or replace heart valves, which control blood flow through the heart Repair abnormal or damaged structures in the heart Implant medical devices that help control the heartbeat or support heart function and blood flow Replace a damaged heart with a healthy heart from a donor. Daniel Hale Williams was a physician who performed the first known open-heart surgery in the United States. In 1952, Floyd Lewis, of Minnesota, reduced the temperature of the body to lessen its need for oxygen while he closed a hole between the two upper heart chambers, the atria In 1967, surgery arrived at a climax that made the whole world aware of its medico surgical responsibilities when the South African surgeon Christiaan Barnard transplanted the first human heart. In World War II the remarkable Dwight Harken, removed 134 missiles from the chest—13 in the heart chambers—without the loss of one patient. Before 1953, the techniques all had one great disadvantage: they were done “blind.” The Purpose of Cardiac Surgery Historical Key Points How the world would deal without cardiac surgery Daniel Hale Williams Floyd Lewis Christiaan Barnard Dwight Harken Ludwig Rhen Théodore Tuffier Alexis Carrel. Works Cited: Cardiac Surgery My topic is what I want to be. I want to be the person that saves lives’ when there’s no hope left. I want to be the person that people go to for help. I want to be a leader. I want to be a Cardiac Surgeon. How is Cardiac surgery a career? The Future of Cardiac Surgery The World without Cardiac Surgery would have a less population due to many deaths that occur from heart problems like: Cancer Heart Attack Ruptured arteries hemorrhage Abnormalities 62 ECG bpm

Cardiac Surgery

Transcript: "My difficulty is not getting surgeons to work – but making them stop." Losing a Patient Demanding Time Consuming Exhausting Yasmine Meliane •Heart disease: 654,092 deaths •Cancer: 550,270 deaths •Stroke: 150,147 deaths Bachelor's Degree Medical College Admissions Test Medical School United States Medical Licensing Test General Surgery Residency Cardiac Surgery Residency Examination by the American Board of Thoracic Surgery Board Certified! On the Job Personal Commitment $259,988 $329,579 $502,276 $589,916 Educational Requirements "I want to give my patients the best quality health care at the lowest price" -Dr. Khanubhai Patel Total Time: 14 years Total Cost: Over $350,000 Lifestyle "The future depends on what you do today." -Ghandi 10th% 25th% 75th% 90th% Negatives -Martin Elliot Cardiac Surgeon Leading Causes of Death Cardiac Surgery Life-Saving Career Problem-Solving Unpredictable Rewarding Exciting Income Positives

Cardiac Surgery

Transcript: Left ventricular outflow obstruction from narrowing aortic valve is gradual Concentric hypertrophy allows LV to maintain SV Increase workload of LV secondary to stenotic valve causes LVH, decreased LV compliance (stiff ventricle) Diastolic dysfunction results from increased LV size, fibrosis, or myocardial ischemia Continued pressure overload eventually leads to decreased SV and CO Anesthetic Plan Medications: $1.25 Monday, September 14, 2015 Intraoperative Events Anesthetic Goals Medical History Transfer to ICU General: Amlodipine Valsartan Nifedipine Atorvastatin Bumetanide Fluticasone/Salmeterol Tiotropium Bromide Prednisone Albuterol Spriva Gabapentin Outcome Vol XCIII, No. 311 Diagnosis: Pathophysiology Labs and Additional Studies Back on CPB Attempt to place IABP via left femoral artery cutdown SFA repair with insertion of IABP Left axillary cutdown and insertion of Impella 5.0 (LVAD) Both decrease afterload and increased forward flow = augment CO Off bypass: Vtach/VF, shockx2, junctional brady, placement of AV pacer wires Avoid Lethal Triad (hypothermia, acidosis, and coagulopathy) Requires hemodynamic support Right Heart Cath: Severe pulm HTN 79/25 (42) mmHG, non-obstructive CAD, severe aortic stenosis and aortic regurgitation from prosthetic valve malfunction Echo: EF 60-65%, mild concentric LVH, diastolic dysfunction, severe pulmonary HTN, dilated LV Maintain NSR, CO is rate dependent due to fixed stroke volume Minimize drug induced myocardial depression by maintaining contractility Maintain intravascular volume, ensure suffient preoload for adequate CO The patient is very sensitive to abrupt changes in intravascular volume NOTE: A reduction in blood pressure or peripheral resistance does not decrease LV afterload because of the fixed resistance against ejection of blood However it does decrease coronary perfusion leading to an increased risk of myocardial ischemia and death Maintain or allow an increase in afterload CXR: Nml EKG: Junctional Bradycardia (44bpm) Airway: MP II TMD >3 MO >3 Neck FROM Dentition intact Placement of lines, ETT, TEE Surgery begins Right axillary artery cannulation Sternotomy Cardiopulmonary bypass Placement of aortic root Destruction of left coronary button CABGx1 SVG to LAD CPB >6 hours Attempt to go off "pump" Na 149 K 3.7 Cl 109 CO2 16 BUN 23 Cr 1.43 Glucose 101 Mg 2.5 Ca 8.6 H&H 8.3/22.9 WBC 7.8 Platelets 65 Coags NORMAL 12th hr into surgery... Subsequent Trips to OR x3 Hemodynamically unstable....epinephrine gtt, norepinephrine gtt, vasopressin gtt, milrinone gtt, LVAD and IABP support Received 7 pRBCs, 6 FFPs, 8 platelets, 2 units cryoprecipitate, 1000ml cell saver (not including what was transfused during CPB ~ 2000ml), 3000ml crystalloids, 1000ml albumin. Coagulopathy treatment: Factor VII, KCentra (pro-thrombin complex contains factors X, IX, VII, II, Proteins C & S, and anti-thrombin III), DDAVP All drips ready (uppers/downers) Blood in room Pre-induction arterial line left radial Defib pads placed prior to induction GETA Smooth controlled IVI Versed/Fentanyl Etomidate SUX/ROC EPI ready Inhaled nitric oxide CVC/PA catheter Be ready to go on BYPASS! Case Study 75/M presents for re-do aortic root replacement due to paravalvular leakage and prosthesis mismatch leading to worsening left ventricular heart failure and progressive shortness of breathe Intraoperative Events Aortic Root Replacement RE-DO 5'5" 87kg BMI: 32 Obese male 30 pack year smoker Still smokes cigars NKDA METs <4 HR: 52 BP: 124/32 RR: 16 SpO2: 99% T: 97.4F Aortic Stenosis Massive Transfusion Protocol #1 Next morning: sternal and left femoral re-exploration with evacuation of hematoma #2 Sternal exploration and washout, removal of IABP, HD catheter placement #3 Exchanged ETT, attempt to close and remove Impella.... HTN Severe aortic stenosis Hyperlipidemia Congestive heart failure CAD COPD w/ pulmonary HTN OSA w/ CPAP GERD Anemia Chronic renal insuffiency Peripheral neuropathy Robinson Rounds 18+ hours later....closing (open chest)

Cardiac Surgery

Transcript: Cardiac Health What is Cardiology? Job Overview Branch of Medicine Study of the Human Heart Deals with Heart Abnormalities & Diseases State of Patient Patient Care Specialists Many types of Cardiologists Dependent upon Specialization Salaries Education College or University Rigorous schooling Very competitive Excellent grades Manuel Dexterity Human Anatomy Work Ethic Requirements Experience Doctorate Degree Residency & Fellowship Work Setting Workplace Hospitals Universities and Colleges Anestesiologists Nurses Other doctors and surgeons Co-workers Interview Dr. Joseph Coselli Thoracic and Cardiac Surgery Works with two hospitals Many years of experience Great work ethic Suggestions Regular Day Several operations per day Long work hours Clinic days Both ups and downs to the job Opinions Conclusion https://study.com/surgeon_education.html Citations ““Anatomical Heart Medical Illustration.” HUMAN ANATOMY CHARTS, 19 Mar. 2017, humananatomyly.com/anatomical-heart-medical-illustration/. Barhum, Lana. “A-Fib Surgery: Types, Risks, and What to Expect.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/316361.php. “Best Cardiologist in Dallas, Phone & Location.” Doctors Nearby, 5 Apr. 2018, www.doctorsnearby.net/best-cardiologist-in-dallas-phone-location/. “Cardiologist Schools.” Study.com, study.com/cardiologist_school.html. “Cardiovascular Surgery.” Temple Health, heart.templehealth.org/patient-care/centers-programs/cardiovascular-surgery. “Điều Gì Xảy Ra Khi Một Người Xuất Hiện Trạng Thái Động Kinh?” Trang Chủ, benhdongkinh.org/benh-dong-kinh-201/benh-dong-kinh-o-nguoi-lon/dieu-gi-xay-ra-khi-mot-nguoi-xuat-hien-trang-thai-dong- kinh.html. “Disease Management.” Heart Transplantation, Clevleand Clinic, www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/heart-transplantation/. “Future - How to Make a Human Heart.” BBC, BBC, 8 July 2014, www.bbc.com/future/sponsored/story/20140529-how-to-make-a-human-heart. “Heart Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Nov. 2017, www.cdc.gov/heartdisease/facts.htm. ifeanyi. “DOCTOR PHARMACIST WHO EARNS MORE SALARY AND SALARY?” Rich Nigerian Pharmacists, Ifeanyi, 7 Apr. 2017, richnigerianpharmacists.com/doctor-pharmacist-who-earns-more- salary-and-salary/. "J. Coselli, email communication, April 18, 2018" “Open-Heart Surgery: Risks, Procedure, and Preparation.” Healthline, Healthline Media, www.healthline.com/health/open-heart-surgery#when-it's-needed. “Stanford University Main Quad.” Dronestagram, www.dronestagr.am/stanford-university-main-quad/. “Stethoscope-on-Book-560.” Biology Students' Association, 24 Oct. 2017, thebiosa.org/2017/10/24/md-consultants-guide-to-medical-school/stethoscope-on-book-560/. “Surgeon Education Requirements and Career Information.” Study.com, Study.com, study.com/surgeon_education.html. Citations

CARDIAC SURGERY

Transcript: C O N D U C T I O N From the SA node the impulse spreads throughout the L) & R) atria and down to the AV node. The Sino atrial node is the hearts dominant pacemaker. It is located at the base of the pulmonary vein in the right atria and its depolarization is depicted as the P wave on ECG Pre-operative ECG is an essential tool in ascertaining baseline conduction attributes or deficits, making diagnosis of any post-operative abnormalities easier. R I S K F A C T O R S M E D I C A L M A N A G E M E N T Drug therapy plays an important part in patient care post cardiac surgery. Statin therapy in the form of cholesterol lowering agents help in slowing the coronary artery disease process. Blood thinning agents such as Aspirin help maximise blood through diseased arteries thus lowering the workload of the heart If the patient has suffered a myocardial infarction; diuretics, anti-hypertensives in the form of ACE inhibitors and rate control agents such as beta-blockers all help to reduce the work demands placed on the heart. These drugs form the cornerstone of medical management for all patients post cardiac surgery. As a nurse it is you role to ensure they are prescribed. Aspirin must be witheld 7 days prior to surgery to lessen the risk of bleeding intra-operatively S U R G I C A L M A N A G E M E N T Two primary issues confronted the original pioneers of open heart surgery; 1: how to maintain blood supply to other vital organs while the heart is stopped 2: how to avoid ischemia in a heart devoid of blood supply In the late 1940s research by Dr John Gibbon resulted in the development of a machine called Cardiopulmonary Bypass (CPB) . Once surgery has been completed and the heart has warmed sufficiently enough to resume a spontaneous rhythm, weaning from CPB is commenced and in some instances defibrillation (5-10 joules) may be required to establish a stable, perfusing rhythm. Once off the CPB, inotropic support and/or temporary pacing are frequently required initially, to ensure adequate arterial pressure, renal function and cardiac output are maintained. Subcostal drains are placed in position and the chest cavity is then closed in layers. The patient is transported directly to the Intensive Care Unit with the anaesthetist for overnight monitoring and pressure support. Haemorrhage is always a risk factor in any type of surgery and frequently can be corrected. Initially post CPB, bleeding may not be apparent until the body warms and blood pressure increases. The volume of drainage into the sub costal drains (tubes that drain from the pericardium, mediasteinum and pleural cavity that are inserted at the time of theatre) alert nursing staff to continued excessive bleeding. If the bleeding is excessive or if the drains become clotted, cardiac tamponade may occur. As blood accumulates in the pericardial space or mediastinum, pressure increases against the heart, reducing ventricular movement2 . In these situations, relief of the pressure is called a sternotomy. Signs and symptoms of cardiac tamponade are : increased heart rate decreased blood pressure and urine output increased CVP excessive or abrupt cessation of SCC drainage. Low cardiac output is another common problem post operatively that may result in stroke or acute renal failure. It can be caused by bleeding, hypovolaemia, arrhythmia, or myocardial dysfunction. The first line of treatment is to ensure adequate (cardiac) preload filling pressures by means of increased volume. Low output despite adequate preload may indicate a problem with cardiac function, i.e. infarction or pre-existing impaired ventricular function. Treatment in this instance usually relies on inotropic support such as Dopamine, Dobutamine, etc. Temporary pacing may also be used to optimise cardiac rate and rhythm. Hypertension may develop from a variety of means, either mechanical, or rebound from cessation of beta-blockers or as the patient wakes from anaesthesia and becomes intolerant to mechanical ventilation and endotracheal suctioning. They may also become increasingly aware of pain. As hypertension exacerbates bleeding and stresses newly sutured vessels, it is important to gain control quickly through the use of ACE inhibitors, beta-blockers, trinitrates, further sedation or analgesia. Arrhythmias are common and usually treated effectively with defibrillation, temporary pacing, electrolyte replacement or anti-arrhythmic medication. Approximately 30% of patients undergoing open heart surgery will experience post operative AF. Stroke is a very real complication of any major surgery, and a small risk exists in the peri operative phase of cardiac surgery also. Should any plaque be dislodged from the aorta during cross-clamping there is always a risk of stroke. Air left in the heart post CPB weaning may result in cerebral ischemia and small emboli may form in the heart chambers secondary to atrial fibrillation or myocardial infarction. 70% of strokes occur on the table and the other 30% in

Cardiac Surgery

Transcript: Meet MD Initial Assessment Pre-Admission Testing Bon Secours Post-Op CVSU Initial Consult Post-Op Follow Up & Cardiac Wellness GOAL! Post-Op CVICU St Mary's Hospital Cardiac Surgery CoPilot Nurse Confused or CoPilot? Transition Home Admission/Operative Day

Cardiac Surgery

Transcript: Presenter Name Cardiac Surgery Vargas, Kelly A brief history... A brief history... 1896 1896 - Alemania Repaired a stab wound to the right ventricle. Dr. Ludwing Rehn Dr. Ludwing Rehn XX Age XX Age 1940s 1940s One of the first pioneers in the field of cardiac surgery, a US army medic serving during World War II. Dr Dwight Harken Dr Dwight Harken Development of Cardiac Surgery Initially, he operated on animals to improve his skills, moving on to soldiers arriving from the European front with bullets lodged in their hearts. Dislodging them almost always proved fatal, but Harken developed a technique that enabled him to cut into the wall of a still beating heart and successfully remove it. With time, more and more of his patients began to survive, proving it was indeed possible to operate on the human heart. Development of Cardiac Surgery Was the next stage in the development of cardiac surgery Closed- heart surgery Closed- heart surgery Closed-or ‘blind’-heart surgery Meant that the heart did not have to be cut open and then closed up again. It was accomplished by passing either a finger or a knife into the mitral valve through an incision in the left atrium in order to remove tissue. Following initial disastrous attempts, Harken’s technique was gradually improved upon, and eventually the procedure was made safe. Hospitals across the world began using the technique. Closed-or ‘blind’-heart surgery Set about finding a solution by work on the open heart without the patient bleeding to death. Bill Bigelow Bill Bigelow Experimenting on dogs He was able to show that by bringing down the patient’s body temperature, the body and the brain continued to function for an extra six minutes on a reduced level of oxygenated blood. This was known as the ‘hypothermic approach’. Experimenting on dogs From the 1950s From the 1950s 1950 1950 The term "open heart surgery" means that you are connected to a cardiopulmonary bypass machine or a pump bypass during surgery. Open –heart surgery Open –heart surgery His heart is stopped while it is connected to this machine. This machine does the work of your heart and lungs while his heart is stopped for surgery. The machine provides oxygen to your blood, transports blood throughout your body and removes carbon dioxide. Process Process 1952 1952 The doctors Walton Lillehei and Dr. John Lewis performed open-heart surgery that is tried for the first time at the University of Minnesota. First Open- heart Surgery First Open- heart Surgery First of all, her body temperature was reduced to 81°F (27.2°C). Secondly, for the ten minutes that followed, Lillehei and Lewis were able to stop the flow of blood, cut open her heart and sew up the hole. Finally, the little girl was immersed in warm water and her body temperature brought back to normal. Her heart functioned properly for the first time. Process of First Open-heart surgery Process of First Open-heart surgery IN 1967 IN 1967 SOUTH AFRICA Dr Christiaan Barnard made the headlines when he transplanted the heart of a young woman into a middle-aged man. First Heart Transplant First Heart Transplant 1970s 1970s - In the fjords of Norway The complex problem of tissue rejection remained an issue throughout the 1970s. In the fjords of Norway that would revolutionize transplant surgery Dr. Norman Shumway (USA) Dr. Norman Shumway (USA) Found in fungus growing in the fjords, would soon be used in hospitals around the world to control organ rejection without cancelling out all resistance to infection. Cyclosporine Cyclosporine Heart surgery is robotized 1980 1980 Incisions to the heart have been reduced to a minimum and patient recovery time is down from six months to a few weeks. Two-thirds of those receiving heart surgery is robotized Two-thirds of those receiving heart surgery is robotized The upper age limit for heart transplants 1997 1997 Who received his heart in 1997 at the age of 65, has so far lived a healthy life 12 years with his new heart, defying statistical probabilities by a large margin. Edward Daumeimer Edward Daumeimer XXI Age XXI Age The Present time 2007 2007 Transplants Tony Huesman Tony Huesman Has become the world’s longest-living heart transplant patient Kelly Perkins Kelly Perkins Heart transplant patient another noted recipient, regularly climbs mountains around the world to promote positive awareness of organ donation 2006 2006 Prognosis for heart transplant Patients Patients The prognosis for heart transplant patients has greatly improved over the past 20 years. Survival rates of five years for such patients stands at 71.2% for men and 66.9% for women. Chronology Chronology 1950s 1940s 1896 1967 Development of cardiac surgery I° Heart Transplant Closed –heart surgery First's Cardiac Surgery Open –heart surgery Conclusion Conclusion Conclusion 1 Conclusion 1 Cardiac surgery is one of the fields of the medicine that has been gradually developed and has been increasing in the last century’s knowledge and forming part of the Thank

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