Hellow guys, Welcome to my website, and you are watching PerfWeb 8 - Validating Graft Patency. Patency coronary bypass grafts (CABG). Devinder Bhatia MD. and this vIdeo is uploaded by PerfWeb at 2018-11-27T13:38:27-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | PerfWeb 8 - Validating Graft Patency. Patency coronary bypass grafts (CABG). Devinder Bhatia MD |
| Video Uploader | Video From PerfWeb |
| Upload Date | This Video Uploaded At 27-11-2018 21:38:27 |
| Video Discription | Lecture and discussion on using different methods and tools to evaluate the quality and patency coronary bypass grafts. (CABG) Faculty: Devinder Bhatia MD Host: Joseph Basha 7:40 Distal anastomosis 7:45 Occlusive problem with bypass graft 8:10 Why evaluate grafts? 8:28 Rationale for graft assessment: Improve patient outcomes Instruct surgeons in training Documentations for peers, stuff and insurance Peace of mind Protect referral network Predictive of outcomes Standardize Care Even though the majority of cardiac surgeons are happy with less then 3% CABG mortality rates, patients are looking for angina relief and a hope of no additional invasive treatment. 10:15 Stents vs grafting 10:30 The prevention of additional intervention represents a socioeconomic benefit to payers (Medicare, private insurers) - and society 10:59 Abnormal grafts and mortality: Poorly function bypass grafts are known to be associated with postoperative morbidity and mortality.* Weman ET AL.** reported that 54.7% of 223 patients who died early after CABG surgery had gross technical problems in the bypasses (unrecognized twisted conduits, stenotic anastomoses and dissections). * Kieser TM, Rose S. et at "Transit time flow predicts outcomes in coronary artery bypass graft patients; a series of 1000 consecutive arterial grafts. Eur Assoc Cardio - thoracic Surg (2010) ** Weiman SM, Salmienen US Penthil - Post mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass 12:00 Prevalence of abnormal grafts 19% of grafts are sub-optimal - in study of 985 cardiac surgery patients with both arterial and venous conduits found abnormal grafts in 19% of patients. 12:26 Transit time flow measurement is a cost effective, safe and easy to use method to access graft patency 12:47 Flow measurement: be suspicious of - any flow less then 15ml/min - high retrograde flow bigger then 3% assess competitive flow - occlude native vessel proximal to anastomosis - graft flow will be bigger and PI will be smaller 13:46 Diastolic filling percentage: (DF) always grater then 50% in coronaries more balanced with systolic filling on right side if heart, DF 50% +/- on left side of heart filling pattern is predominantly diastolic, DF 70% +/- 15:05 how to spot a bad graft: occluded LIMA - DIAG example: 15:33 Abnormal diastolic filling pattern and percentage 15:51 Low mean flow value - high pulsatility index 16:17 Measured curve differs from the FloWizard flow curve and values 16:19 how to spot a bad graft examples: Occluded LIMA and LAD graft - revised LIMA and LAD graft 16:29 Unexpected results: The surgeon - a gifted local CT surgeon - ME Single vessel OPCAB - LIMA to LAD No surgical complications Clinical observation normal TEE appeared normal Hemodynamics appeared normal Palpation - Pulsatile Conclusions Patent graft 16:32 Kinked Graft - before and after 17:52 What we do? Acoustic Coupling Index (ACI) should be green Mean Arterial Pressure (MAP) near 80mm hg Probe placement: No curves Not near proximal anastomosis Probe size correct for vessel size: IMA : 2-3 mm SVG : 3-5mm 19:20 Spasm - spikey wave form kinks - low flow / high PI twists - low flow high PI length - low / flat DF% 19:46 Low mean arterial pressure (MAP) Vascular resistance Competitive flow Time point Arterial spasm 22:32 Real example Faculty: Devinder Bhatia MD Host: Joseph Basha |
| Category | Education |
| Tags | Joe Basha | Perfusion | Perfusionist | Perfusion Continuing Education | Perfusion Talks | Heart Surgery | perfusion school | graft patency | graft cabg | cabg graft | cabg graft sites | cabg graft names | cabg graft patency | heart surgery grafts | coronary bypass graft | Devinder Bhatia MD | heart bypass surgery | graft vs stent | cbag surgery | transit time flow measurement | acoustic coupling index | mean arterial pressure explained | arterial spasm | coronary artery bypass | LIMA |
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