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Pre Operative tests in Cardiothoracic Surgery

Pre Operative tests in Cardiothoracic Surgery. Why. FBC. HB Anaemia ? Why Anticoagulation type of valve Polycythaemia WCC neutrophilia neutropaenia True or false Prosthetic valve endocarditis has ~50% mortality Leukaemia PLT Thrombocytosis Thrombocytopaenia

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Pre Operative tests in Cardiothoracic Surgery

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  1. Pre Operative tests in Cardiothoracic Surgery

  2. Why

  3. FBC • HB • Anaemia ? Why • Anticoagulation type of valve • Polycythaemia • WCC • neutrophilia • neutropaenia True or false • Prosthetic valve endocarditis has ~50% mortality • Leukaemia • PLT • Thrombocytosis • Thrombocytopaenia • Aspirin and clopidogrel have no effect

  4. U & E • Na • Paraneoplastic in Ca lung • Confusion in old grannies • Diuretics • K • Arrthymias • Paraneoplastic in Ca lung • Diuretics • Urea • GI bleed • Diuretic use • Dehydration • Creatinine • Major risk factor for dying post cardiac surgery

  5. LFTs and calcium • LFTs • Alcoholics major risk factor • Metastasis in lung cancer • Right heart failure • Drugs eg Statins • Ca2+ • Metastasis in lung cancer • Paraneoplastic

  6. Clotting • Pro coagulant • Protein C • Protein S • antithrombin III • VonLeiden • Lupus anticoagulant ONLY ONE WITH ABNORMAL LABS • Block the grafts • Bleed • Monitor heparin and warfarin therapy and reversal • Von Willibrands • Haemophilia A • Christmas disease (Haemophilia B)

  7. Glucose • 1ST OR 2ND on list • Diabetes is major risk factor for dying • Poorly controlled means metabolic problems post operatively • Newly diagnosed in CABG patients • HBA1c or Fructosamine

  8. ECG • Normal or not • Rate eg brady or tachy • SR / AF • PR interval • LV hypertrophy • Bundle branch block • ST levels in CABG • ST curvature in lung and oesophageal cancer • Pacemaker

  9. PFTs • Epidural use • Nebuliser use • Risk of thoracotomy • Valve patients different to CABG patients • DLCO / VA • Thoracic surgery • Rule of 19 for predicting post operative FEV1

  10. CXR - Cardiac • Size heart • Risk • Cardioplegia • Trauma • Aortic calcification CVA risk eg Cannulation ? Off pump • Lung cancer as most are ex or current smokers • #ribs ? #sternum in past • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA • Valves and Warfarin

  11. CXR - Thoracic • Size heart • Risk • Trauma • Growth of tumour • Pleural effusion • Pulmonary mets • #ribs ? #sternum in past • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA especially in Left upper lobectomy • Valves and Warfarin

  12. CXR - Oesophageal • Size heart • Pleural effusion • Pulmonary mets • ? see tumour • Wires / clips from previous sternotomy • Beware Ethibond or wire removal • Think LIMA • Valves and Warfarin

  13. CXRs

  14. Angiogram – Isolated CABG • Aortic calcification • Amount aortic regurgitation • LV function • What needs doing • Conduits to use • LIMA • RIMA • Radial • Vein

  15. Angiogram – Isolated Valve • ? needs CABG • LMS length • Circ size in mitral surgery • Aortic calcification • Amount aortic regurgitation • LV function • Aortic valve calcification ? CVA risk

  16. CT - Cardiac • Redo surgery ? RV and sternum separation • Aortic sizes ? Need root or arch • Follow up of descending aorta • Planning coarctation

  17. CT - Thoracic • Thoracic surgery • Tumour • Mediastinal LNs • Metastatic spread

  18. CT - Oesophageal • Oesophageal Surgery • Tumour ? Left or Right approach • Trachea • Mets

  19. Echo • All murmurs need evaluating • Always check “supposedly normal valves” • Pulmonary and tricuspid valves rarely commented on with mitral valve patients • PA pressure MAJOR risk factor • LV and RV function

  20. Weight • Tamponade • Leg wound healing • Breathless patients ? Need diuretics

  21. BP • Left and right arm for LIMA • Level that kidneys and brain expect • Aortic dissection

  22. Swabs • Sternal wound and valve infection • Prosthetic valve endocarditis mortality 30 to 50 %

  23. Carotid scans • Type of operation • Blood pressure on bypass • Risk of stroke • ? Combined procedure • Post operative medications

  24. Clinical ExaminationDON’T UNDERESTIMATE THE IMPORTANCE OF THIS

  25. Next week26th JanThoracic SurgeryLecture Theatre

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