SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: CODE: PRACTICE

LEVEL: III /IV
ANDREA VILLAMIZAR BLANCO 01200021056

TEACHER'S NAME: Lidy Higuera PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE:

CARDIOVASCULAR DR. GIRALDO 09/08/2023

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE:

ERNESTO RUEDA SUAREZ 13800641 76 AÑOS

SURGICAL PROCEDURE TO PERFORM:

AORTIC VALVE REPLACEMENT

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. Surgical Objective: (Make description)

replace the damaged aortic valve with a new one, it can be biological or mechanical
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1.2. Anatomy and physiology: (Make graph and description).

The aortic root is a complex structure linking the left ventricular outflow tract and the ascending aorta, made up 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

The proximal limit of the aortic root is determined by the basal insertion of the leaflets into the left ventricle and extends
distally to the sinotubular junction, where it is continued by the ascending or tubular aorta. The aortic annulus is crown-
shaped and is the site where the leaflets are inserted, thus forming 3 commissures at the highest junction site between
them and 3 sinuses of Valsava.

The aortic leaflets are three triangular fibrous structures that coapt together in the shape of a cup. They have greater
consistency in their free edge and are more lax in their body. At the midpoint of their free edge of coaptation they have a
fibrous thickening known as the Nodule of Arancio.
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The sinuses of Valsalva are small saccular dilatations of the aortic root. They are limited by the aortic wall, which is less
thick at this height, and its respective leaflet. Under normal conditions, the coronary arteries arise respectively from the
right and left coronary sinus, leaving a third non-coronary sinus.

The aortic annulus is not a single structure, but rather consists of 3 components: the sinotubular junction, the ventriculo-
aortic junction, and the crown-shaped annulus that serves as an attachment for the leaflets. These three components
work together to make up the functional aortic annulus.

The coordinated dynamic action allows the unidirectional transmission of blood from the left ventricle to the aorta through
a channel that allows maintaining a laminar flow, with minimal resistance, optimizing coronary flow and with the least
possible damage to the blood elements.

The aortic root could be defined as the portion of the left ventricular outflow tract that contains the aortic leaflets limited
above by the sinotubular junction and below by the basal ring at the level of aortic leaflet implantation. The aortic root
acts as a single hemodynamic complex that undergoes changes (expansion/contraction) during the cardiac cycle.

There is a normal relationship between the length of the free edge of the leaflet and the length of its base of
implantation. This ratio should be 1/1.5; that is, any increase in the length of the free edge of the leaflet modifies
this relationship; this is the mechanism of aortic valve prolapse
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 SURGICAL INSTRUMENTATION PROGRAM

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1.3. Check list:

MEDICAL EQUIPMENT/ DRUGS AND

DEVICES SUTURES AND SOLUTIONS
INSTRUMENTAL
NEEDLES

-Eq. extracorporeal- -Pack of Heart- R. Pericardium:-Silk 0 -Saline

Eq. Accessory-Valve Compresses-Gauze- SHArterial and
Gauges- Fields for two- venoustobacco bags:- solution- infiltration
Reciprocating Saw- Handlebars-Accessory Polyester 2/0 needle
Sternal Retractor- Robes-Gloves-Gauze ½C.R. 25cmTobacco
Defibrillator paddles- container-Short sharps Vent
Clamp dr. giraldo container-Electro scalpel- Bags,Cardioplegia and
Alligators-Rubber aorticclosure:-
Suction-Yankawer Polypropylene
cannula-Aseptosyringe- 4/0needle ½ C.R.
Tourniquets-20 and 10 ml 17cmFixation of
syringe-Arterial cannula Cannulas:-Silk 1
20 fr-Venous Cannula 24 PrecutAorta Repairs:-
fr-tube to chest-Nelaton Silk 4/0 vascular Valve
probe #8 and 14-Rigid Setting:-Valve Kit-
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pericardiumaspirator- Pacemaker
Vent aspirator-Ioban- wireSternal: -Surgical
Antegrade and Wire 5Muscle:-
ostiumcardioplegia Poliglactin 910
cannula-Three-way 2/0Skin:-
tap(cardioplegia)- PoliglecaproneChest
Connectors-pink needle- tube fixation:-Polyester
Aortic valve-Pathology 2/0
Flask whitplushPacemaker
wirefixation:-Silk 2/0
1 Scalpel Blades 11- SHHemostatics:-Bone
1 Scalpel Blades 15 Wax-Bioglue

2. ORGANIZATION STAGE:

a. Arrangement of May tables and reservation (make scheme).

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2.2. Patient position (Name and graphic):

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2.3. Location of the Surgical Team (make a graph):

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3. EXECUTION STAGE:

a) Anesthesia (write the type of anesthesia):

general

b) Incision (write the type of approach and the name of the incision):

sternotomy
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c) Surgical Process (Describe the main steps of the surgical medical technique with the instruments to be used).

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 pericardiu

WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES

STUDENT SIGNATURE: TEACHING SIGNATURE: __________________________