Myocardial

revascularization +
change of aortic
valve
Lorena Aguilera Camacho
ANATOMY
Coronary arteries are the blood vessels
that supply blood to the heart muscle.
These arteries provide oxygen and
nutrients needed for the heart.

The aortic valve is one of the four heart

valves and is located between the left
ventricle and aorta. This valve allows
blood to flow from the left ventricle to
the aorta.
 PATIENT
60-year-old patient in surgical
protocol for myocardial
revascularization + aortic valve
change (biological). It is
considered suitable by the
anesthesiology service, it explains
the risks of the patient and
possible complications arising
from anesthesia.
PATIENT DATA
Name: Roberto Silva Rodriguez
Age: 60
Weight: 88kg
HB: 14
HTO: 45
PLAQ: 133.000
LEUCOS: 6100
PCR: 0,75
Hepatitis: Negative
Uroanalysis: 5.0
Albumin: 4.5
Sars Cov 2: Negative
 DIAGNOSTIC METHODS

● CORONARY ARTERIOGRAPHY WITH LEFT

CATHETERIZATION:

● Cirumflex artery:
Calcification obstruction in the circumflex artery
with 70-90%
 RISKS
• Bradycardia
• Hypotension
• Tachycardia
• Coagulopathy
• Acidosis
• Hypoglycemia
• Pneumothorax
• Pneumonia
• Nosocomial Infections
 TREATMENT
Myocardial revascularization is
performed to restore blood supply
to blocked coronary arteries, while
aortic valve change is performed to
correct a damaged or narrowed
aortic valve.
 INDICATIONS
• Stenosis: thickening of the valve
tissue that causes narrowing of
the hole.
• Insufficiency: inability of the
valve to close completely
causing reflux or blood leakage.
CHECK LIST
SURGICAL TABLES
SURGICAL TABLES
PATIENT POSITION
SUPINE POSITION
 SURGICAL PROCEDURE
• Count of gauze and compresses
• Incision with m #7 hb#15.
• Apprehension and electrocoagulation instruments for deep tissue
incision: electrobisturi
• Sternotomy: reciprocating saw equipment with down saws
• Manual sternum separation: Farabeuf type separators.
• Hemostasis of the sternum: electrobisturi
• Hemostasis of the sternal periosteum and for hemostasis of the bone
marrow: bone wax, electro in 60.
 SURGICAL PROCEDURE
• Pass microvascular dissection and electrocautery in 20 for dissection of the mammary artery.
• For ligation and hemostasis of this, use Ligaclip forceps and the clip cartridge and Metzembaum
scissors.
• Pass vascular type dissection and electrocautery in 40 for the opening of the pericardium.
• Suture silk 0 for pericardial repair
• Clamp passes threads and 1 pre-cut silk, for the venas cavas, upper and lower, and tourniquet to
repair these.
• Suture polyester 2/0 for tobacco bags in: Ascending aorta, superior vena cava and inferior vena
cava.
• Polypropylene 4/0 suture for small bags in: Aorta root
• Prepare adequate cannulas for patient perfusion
• Mb#7 hb#11 for arteriotomies and venotomies
• Pre-cut silk 1 for fixing the placed cannulas
• Mb#7 hb#11 for atrial incision, long metzembaum scissors to enlarge atria
• Cushing separators, for viewing the atrial septum
 SURGICAL PROCEDURE
• MB#3 HB#11 and vascular dissection to cut the aorta, then pass long tissue scissors.
• Coronary perfusion cannula, for direct antegrade cardioplegia in coronary ostium.
• Silk 4-0 to repair the walls of the aorta.
• vascular grasping forceps and scissors for dissection and removal of the aortic
valve.
• It is washed with saline solution.
• The valve is measured with the gauge.
• The nursing assistant pass the valve device to be implanted.
• the valve to be implanted is biological, wash it according to the protocol.
• 2-0 vascular polyester suture in each respective repair.
• 4/0 polypropylene for aortic root, tourniquet and antegrade cardioplegia cannula
PROCEDURE
PROCEDURE
PROCEDURE
THANKS!