Lesson Objectives:
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Compare PCI vs. CABG for coronary artery disease.
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Review indications for valve replacement (TAVR vs. surgical).
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Understand the role of mechanical circulatory support (LVAD, ECMO).
PCI vs. CABG – When to Choose?
| Criteria | PCI (Stents) | CABG (Surgery) |
|---|---|---|
| Indications | 1-2 vessel disease, STEMI/NSTEMI | Left main disease, 3-vessel CAD, DM |
| Recovery | Fast, <1 week | Slower, ~6 weeks |
| Long-term outcomes | Higher restenosis risk | Better long-term survival |
Valve Interventions: TAVR vs. Surgical AVR
✔️ TAVR (Transcatheter Aortic Valve Replacement)
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Indicated for severe aortic stenosis (AS) in elderly/high-risk surgical patients.
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Less invasive than open surgery.
✔️ Surgical AVR (Aortic Valve Replacement)
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For younger, low-risk patients or those needing complex repairs.
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Requires sternotomy and cardiopulmonary bypass.
Mechanical Circulatory Support (MCS)
🚨 Left Ventricular Assist Device (LVAD)
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Used in end-stage HFrEF as bridge to transplant or destination therapy.
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Requires lifelong anticoagulation.
🚨 Extracorporeal Membrane Oxygenation (ECMO)
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Veno-arterial (VA-ECMO): For cardiogenic shock, cardiac arrest.
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Veno-venous (VV-ECMO): For severe ARDS, respiratory failure.