Minimally invasive treatment for coronary artery disease

Coronary artery disease is the leading cause of morbidity and mortality in the United States. One advancement in the treatment of this disease is the minimally invasive direct coronary artery bypass (MIDCAB) procedure, which is an alternative to the traditional open heart bypass procedure. The MIDCAB procedure is becoming a viable alternative to the traditional coronary artery bypass grafting procedure for a select group of patients. With further experience and follow-up, this procedure will offer lower hospital costs by decreasing lengths of stay and offering patients the optimal conduit for coronary artery bypass grafting without the complications of cardiopulmonary bypass.

Minimally invasive direct coronary artery bypass surgery

Traditional coronary artery bypass surgery involves a median sternotomy and the use of a heart-lung machine to stabilize the heart during suturing. Minimally invasive coronary artery surgery employs small incisions directly over the target vessels and avoids the use of a heart-lung machine, which can cause postoperative complications. The target coronary vessels are stabilized in alternative ways, potentially hazardous manipulation of the ascending aorta is avoided, and the subclavian and axillary arteries provide alternative inflow sources. Other new techniques used in minimally invasive procedures include a coronary artery cannula to avoid intraoperative ischemia and wound irrigation catheters to administer postoperative bupivacaine hydrochloride. Perioperative nurses need to become familiar with these new techniques to be able to plan and implement effective patient care.

A collaborative approach to minimally invasive direct coronary artery bypass

Minimally invasive direct coronary artery bypass (MIDCAB) graft is a surgical technique that is becoming more widely accepted. Through a collaborative effort--interhospital and intrahospital--surgical team members at two hospitals in Kentucky made significant improvements on the MIDCAB procedure that positively influenced patient outcomes (e.g., less time in intensive care, shorter hospital stays, fewer complication, cost savings to the patients and institutions). This article reviews those collaborative efforts and outcomes.

Total arterial revascularization of the heart: intentional or inevitable

The impact of left internal mammary to left anterior descending coronary bypass grafting in enhancing long-term patient survival has led to a widespread interest in arterial grafting over the past decade. It is now accepted that the internal mammary artery is a biologically superior coronary bypass graft compared with the traditional saphenous vein. Experience with other arterial grafts--the right gastro-epiploic artery, the inferior epigastric artery and the radial artery--has shown compelling evidence that they share the same biologic advantage. With the judicious use of some or all of these conduits, all regions of the heart can be reached, and total arterial revascularization is a feasible and desirable objective on a routine basis. As long-term results become available, it is inevitable that it will become the operation of choice.

Sternal wound management: a case study. Nursing grand rounds

The complication of mediastinitis has important implications for nurses. This article describes the case of a man who developed a sternal wound infection following coronary artery bypass surgery. Nursing care is discussed and is summarized in care plans for the diagnoses Ineffective Breathing Pattern, Impaired Skin Integrity, and Ineffective Coping. Expert nursing care resulted in hospital discharge approximately two months after admission.

Postoperative nursing management in patients undergoing myocardial revascularization with the internal mammary artery bypass

The IMA is being utilized with increasing frequency as the graft of choice for myocardial revascularization. Certain postoperative management requirements differ in patients with the internal mammary bypass, which are often challenging. Because it is important that the nursing staff have a thorough understanding of the peculiarities of postoperative care in patients with IMA grafts, this article was prepared to review the anatomic, pathologic, physiologic, and clinical aspects of the IMA in myocardial revascularization. A retrospective comparative chart review of patients with IMA grafts and SVGs was also performed to better define the specific postoperative nursing problems of hemorrhaging, pulmonary support, and pain control that are encountered in these patients.