Aortic valve

replacement

Anguie Tatiana Herrera Hernandez 01200021060

 ANATOMY
The aortic root is a complex union structure between the left
ventricular outflow tract and the ascending aorta, composed
of the following structures, which work together to achieve
normal valve function:

• aortoventricular junction
• intervalval triangles
• The zone of insertion of the leaflets and the commissures
• Aortic Leaflets
• the sinuses of valsalva
• sinotubular junction
 Physiology
It is not a rigid and static structure. Its dimensions change
with the cardiac cycle to facilitate ejection of the left
ventricle in systole and closure of the aortic valve during
diastole.

In all this dynamics of the cardiac cycle, the sinuses of

Valsalva and the intercommissural triangles play a crucial
role. For this reason, repairs in which these elements are
preserved are more "physiological" and at least
theoretically preferable.
 Clinical Case
Name: Juan Perez
Age: 58 years
Gender: Male
Background: Chronic arterial hypertension, smoking (15 years of smoking), hypercholesterolemia.
Reason for consultation: The patient Juan Pérez was referred to a cardiologist for presenting symptoms such as
fatigue, mild dyspnea (difficulty breathing) when performing physical activities, and occasional chest pain for
approximately 2 months. These symptoms had gradually progressed.

Clinical History: The patient had a history of chronic arterial hypertension and had been diagnosed with
moderate aortic valve regurgitation 3 years ago. At that time, her echocardiogram showed mild aortic root
dilatation and moderate to severe aortic valve regurgitation. Medical management was chosen and the patient
received treatment with angiotensin-converting enzyme (ACE) inhibitors and statins to control hypertension
and cholesterol.
Over the next 2 years, the patient was regularly monitored with echocardiograms and his symptoms remained
stable. However, in recent months, he began to experience more pronounced fatigue and dyspnea with
minimal physical activity.
 Clinical Case

Current Assessment: The patient underwent a cardiology assessment

including an echocardiogram, which revealed significant deterioration in
aortic valve regurgitation. The aortic regurgitation had become severe,
and left ventricular function was compromised due to volume and
pressure overload. The aortic root also showed greater dilation.

Therapeutic Decision: The patient underwent aortic valve replacement

surgery. During the intervention, the previously implanted valve
prosthesis was removed and a new biological aortic valve prosthesis was
implanted. The surgery was successful and the patient was transferred to
the intensive care unit for postoperative recovery.
CHECK LIST
 SURGICAL TEAM POSITION PATIENT POSITION

Anesthesiologist

Perfusionist
Nurse
Surgeon

Assistant
Surgical
Instrumentation

Supine Position
MAY TABLE ARRANGEMENT
RESERVATION TABLE ARRANGEMENT
 TÉCNICA QUIRÚRGICA
-May table arrangement and reservation
-Patient's dress
-Count of compresses and gauze
-Fixing pipes and lines with straight kellys
-Dress of the surgeon and assistant

STERNAL OPENING TIME:

-To make an incision, go to the surgeon MB# 7 and HB# 15
-Pass to surgeon dissection and electrocautery for deep tissue incision.
-Pass wire cutters and needle holders to remove the surgical steel for reoperation
-For sternotomy pass to surgeon oscillating saw equipment
-For manual separation of the sternum, go to the Farabeuf separator surgeon.
-Pass bone wax, electrocautery in 60 for hemostasis of the sternal periosteum and bone marrow.
-Pass to the surgeon the sternal protectors and the self-retaining retractor for the fixed retraction of the sternum.
-Pass to the surgeon vascular type dissection and electrocautery device in 40 for the opening of the pericardium.
-Pass needle holder with 0 silk suture to repair the pericardium.
VASCULAR TIME:
-Pass vascular dissection, Mayo scissors and 2/0 polyester suture for the
surgeon to make the tobacco pouches in:
-Ascending Aorta
-Right atrium
-Prepare 4/0 polypropylene for the surgeon to make the tobacco pouches in:
-Right Superior Pulmonary Vein (Vent Aspirator)
-Prepare pass threads (tourniquet) and Kelly to refer the tobacco bags made
by the surgeon.
-Prepare the appropriate cannula for the patient's infusion as appropriate.
-Go to the surgeon HS# 7 SB# 11 to perform the arteriotomy to perform the corresponding cannulation.
-Prepare pre-cut silk 1 for fixing the placed cannulas by passing them through the surgeon's hand.
-Prepare tube clamp and gauze for purging the arterial cannula.
-Pass to surgeon HS#7 SB#11 to make the incision in the right atrium.
-Pass the long Metzembaum scissors to the surgeon to widen the incision and perform the corresponding cannulation.
-Prepare pre-cut silk 1 for fixing the placed cannulas by passing them through the surgeon's hand.
-Prepare suitable connectors for the connection of the cannula to the extracorporeal circuit.
-Go to surgeon HS#7 SB#11 to make the incision in the right upper pulmonary vein.
-Go to the surgeon P. Kelly Adson to widen the incision and perform the corresponding cannulation.
-Prepare total occlusion vascular clamp for the surgeon to perform aortic clamping.
CORRECTION TIME:

-Pass to the surgeon HS#3 SB# 11 and vascular dissection to incise the aorta, later pass long tissue scissors.
-Pass suction cannula of the machine, to collect the blood.
-Pass coronary perfusion cannula, for direct antegrade cardioplegia in coronary ostium.
-Silk pass 4-0 to repair the walls of the aorta.
-Pass vascular grasping forceps and scissors for dissection and removal of the aortic valve.
-Keep in mind that when the valve is calcified, the surgeon removes the valve using allix forceps, scissors, and
vascular grasping forceps.
-It is washed with saline solution, remember to place an extension to the aseptosyringe
-The valve is measured with the gauge approved by the surgeon and confirmed.
-The nursing assistant is asked for the valve device to be implanted, confirmed aloud.
-If the valve to be implanted is biological, wash it according to the valve device washing protocol.
-Pass the valve to the assistant surgeon.-Support the surgeon in the passage of the sutures in the valve annulus.
-The surgeon is passed a 2-0 vascular polyester suture in each of the posts and the respective repair, then the
following sutures are passed, taking special care not to repeat the color of the thread.
-After implantation of the medical device, pass a closing suture (prolene 4-0 16mm round needle with pledget).
-Ready root suction.-4/0 polypropylene pass for aortic root purse string, tourniquet and antegrade cardioplegia
cannula for deaeration.
CLOSING TIME:

-Prepare warm saline solution, to speed up patient warming.

-Prepare for aortic unclamping and removal of the patient from extracorporeal circulation.
-Pass Mayo scissors, vascular dissection and assist the surgeon at the time of removal
of the cardiovascular cannulas, anticipating partial occlusion clamp and reinforcing
sutures with and without supportfrom pledget.
-Pass pacemaker wire so that the surgeon can position them as
he sees fit in the atrium and ventricle.
-Pass HS#3 SB#15, vascular dissection, suture and Long Metzenbaum Scissors and chest tubes
so that the surgeon can position them as he sees fit in the pleurae and mediastinum respectively.
-Nelaton 14 probe is inserted for chest tube aspiration
-Assist the surgeon in general hemostasis with electrocautery of the surgical area, providing suture material, gauze,
compresses and hemostasis elements.
-Verification of counts
-Prepare number 6 surgical wire, Rochester, needle holder, and wire cutters for the surgeon to face the sternum.
-Prepare 2/0 or 3/0 polypropylene to face the muscles and subcutaneous tissue with needle holder, claw
dissection, and Mayo scissors.
-Prepare poliglecaprone to face the skin with needle puller, adson dissection with claw and mayo scissors.
-Make the patient heal by cleaning and covering the wound with dressings and/or adhesive tapes.
 BIBLIOGRAPHY
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