Aortic Surgery and Mechanical Circulatory Support Flashcards

Spinal cord ischemia is a feared complication of thoracoabdominal aortic aneurysm repair and is reduced by:

Answer: Reimplanting intercostal arteries and using cerebrospinal fluid drainage

Reimplanting critical intercostal arteries (T8–T12) and draining cerebrospinal fluid to reduce spinal cord perfusion pressure are the most effective strategies against spinal ischemia.

In acute Type B aortic dissection, the primary indication for emergency intervention is:

Answer: Malperfusion syndrome, rapid expansion, or impending rupture

Uncomplicated Type B dissection is initially managed medically, but malperfusion, rapid aneurysmal expansion, or rupture mandate urgent TEVAR or open surgery.

The left ventricular assist device (LVAD) as destination therapy is indicated for patients with:

Answer: End-stage heart failure ineligible for transplantation requiring permanent mechanical support

Destination LVAD therapy provides permanent support for end-stage HF patients who are not transplant candidates, improving survival and quality of life.

The most common cause of death in patients supported on long-term LVAD therapy is:

Answer: Stroke (neurological events)

Stroke is the leading cause of death and disability in long-term LVAD patients, resulting from thromboembolic or hemorrhagic events related to the device.

Which imaging study is the gold standard for preoperative planning of thoracic aortic surgery?

Answer: CT angiography (CTA) of the chest, abdomen, and pelvis

CTA of the entire aorta provides precise anatomical detail of aortic dimensions, branch involvement, and landing zones essential for surgical or endovascular planning.

Heparin-induced thrombocytopenia (HIT) in cardiac surgery patients is managed by substituting heparin with:

Answer: Bivalirudin or argatroban for anticoagulation during CPB

Bivalirudin is the preferred alternative anticoagulant for CPB in confirmed or suspected HIT, as it does not cross-react with HIT antibodies.