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Technology's Role in Anatomy and Physiology

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by Alexandra F. on 9 June 2013

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Transcript of Technology's Role in Anatomy and Physiology

Coronary Artery Surgery Through the Years Technology's Role in Anatomy and Physiology CABG Animation Video What is CABG & How Does it Help Patients? Cons of CABG Because, CABG is a safe operation with surgical mortality rate of 1-2%, patients don't "suffer" from this surgery. The only con of the surgery is that there is a small chance that CABG could fail and arteries could become blocked again
factors that affect surgical mortality:
age, sex, degree of cardiac dysfunction, obesity, renal impairment, cartoid artery diseases, etc. Coronary Artery Bypass Surgery Adam Hammer establishes that heart attacks occur when at least one coronary artery is blocked 1950 Alexis Carrell presents a paper describing coronary artery bypass Arthur Vineberg reroutes internal mammary artery into heart muscle 1910 D.W. Gordon uses sections of mammary, axillary or carotid arteries, to replace diseased left anterior descending artery sections 1953 Sidney Smith harvests saphenous vein from leg and uses it as a graft from aorta to direct blood flow into the myocardium 1955 Robert Goetz and Michael Rohman performed a single mammary artery bypass to anterior descending coronary artery and implanted a tantalum stent 1960 1876 William Mustard does first direct joining of carotid to coronary artery. Patient doesn't survive. 1962 Sones and Shirley at Cleveland Clinic use angiography to visualize blockages in coronary arteries Overall Pros of CABG AKA: CABG (Coronary Artery Bypass Grafting) it significantly improves symptoms of angina, exercise capacity, and reduces the need for medications
it reduces the chance of further heart attack
it significantly improves long term survival (10 years) Coronary Artery Bypass Surgery is a type of surgery that improves blood flow to the heart
CABG is used to treat people with severe Coronary Heart Disease (CHD)
CHD= build up of plaque inside an artery which causes a reduction of oxygen-rich blood to the heart
a blood clot can also occur, which could completely block blood flow from a coronary artery to the heart. This is the most common cause of a heart attack.
How Does it Work?:
A healthy vein/artery is taken from the body (usually the leg) and connected (grafted) to the blocked portion of the coronary artery
This creates a new path for the oxygen rich-blood to flow
Multiple coronary arteries can be bypassed during one surgery (single bypass, double bypass, triple bypass, quadruple bypass, quintuple bypass) after surgery complications could include the following: heart attack, stroke infection, hemorrhage, and CABG failure
early failure rate of CABG is about 10-15%
a majority of the patients enjoy long-term benefits after CABG
the most common cause of graft blockage is development of atheromatus disease in the grafts no conditions of heart disease prior to onset of symptoms
had heart attack:
mid-left anterior descending artery 100% blocked
stent placed in blocked artery to help keep blood flowing
however, this didn't work
doctors then decided to perform CABG
she underwent a triple bypass surgery
5-6 weeks recovery time with cardiac rehab
as of now, she is perfectly fine!
no physical limitations imposed
just regular drug maintenance
patients at younger ages are able to rebound faster after surgery PATIENTS WHO HAVE BENEFITED FROM CABG Patient #1: My Mom Patient #2: Chuck Gomez patient experienced severe heartburn and pressure in chest
suffered a major heart attack
heart was severely damaged and walls were paper thin
doctors put him in a medically-induced coma for four days
high chance that he was going to die
heart was in danger of rupturing
underwent quadruple bypass surgery
after 2 weeks he was learning to walk again and underwent occupational therapy
this surgery literally saved his life
today, he is back to his everyday life and continues writing as a news journalist CABG Failures and Cons patient underwent CABG (double bypass)
less than 5 months later patient experienced shortness of breath and chest pain
surgeon didn't know why both bypasses closed up
went to another hospital where surgeons rerouted the arteries with two larger stents
patients life was saved
now, after stents have been put in, patient is feeling chest pain again and then same pain she felt after the CABG had failed
doctors are trying to figure out if stents now failed too
this is a rare case as CABG failure rate is about 10% Patient #1: name not disclosed FUTURE OF CABG Developments include minimally invasive techniques such as totally endoscopic, robot-assisted CABG
technical issues have prevented its widespread acceptance, so more advancements still need to be made
Right now, CABG & Percutaneous Coronary Intervention (PCI) are the two procedures for patients in need of revasculaization
Research is constantly being done to determine which procedure is the most beneficial for specific conditions
Currently, there is a study being done to test the effects of both procedures on mortality modified by patient characteristics
Another study is currently being conducted to investigate the role of age in PCI and CABG
Some surgeons would also like to see a greater emphasis on involving patients in the decision-making process for CABG
by: Alexandra Fall http://www.healio.com/cardiology/vascular-medicine/news/print/cardiology-today/%7BCF9F06E0-60A6-4F1C-93CF-A475D7A8651A%7D/CABG-PCI-debate-continues-with-new-research-emerging-technologies

https://www.dcri.org/research/news/2012-news-archives/patients-who-have-graft-failure-after-cabg-are-more-likely-to-have-heart-attacks

http://www.ncbi.nlm.nih.gov/pubmed/12058791

http://www.nhlbi.nih.gov/health/health-topics/topics/cabg/
Sources: Patient #2: name not disclosed 57 year old patient
had two open heart surgeries
2009-had first heart attack and had triply bypass surgery
2010-had second heart attack and doctors discovered that two of the three grafts had failed
patient then had a second CABG ( double bypass)
now patient's grafts are failing again with only one functioning properly
it appears that the patient's immune system is rejecting the grafts
patient will undergo an angioplasty
this is the last thing doctors can do before the having the patient's heart transplanted
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