SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: Karen Daniela Bautista Esquivia CODE:01210021064 PRACTICE LEVEL: III

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

SPECIALTY: CX SURGEON: DATE: 16/02/2024

CARDIOVASCULAR Dr. Giraldo
NAME OF PATIENT: Samuel Plata Orejarena MEDICAL HISTORY NUMBER: PATIENT AGE: 73 Años
5754987
SURGICAL PROCEDURE TO PERFORM: AORTIC VALVE REPLACEMENT

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

Surgical objective

It is a surgical procedure through which the correction of the

damaged or affected aortic valve is performed to improve blood
flow.

https://www.cirugiacorazon.com/que-
operamos/cirugia-valvular/cirugia-de-la-
valvula-aortica/
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Anatomy

The aortic valve is one of four valves that regulates blood flow through the heart.
These valves keep blood flowing in the proper direction through the heart.

The aortic valve separates the main pumping chamber (left ventricle) and the main
artery that supplies oxygen-rich blood to your body (aorta). With each contraction
of the ventricle, the aortic valve opens and allows blood to flow from the ventricle.
left towards the aorta.

It is made up of three semilunar-shaped fragments of tissue, the velums, which are

attached to the wall of the aorta and separate it from the left ventricle. Probably
rather than talking about a valve, we should talk about a “valvular complex”
formed by the leaflets, the commissures, the intercommissural triangles, the
sinotubular junction and the wall of the aorta itself in the sinuses of Valsava and
which corresponds to the root of the aorta. When the ventricle relaxes, the aortic
valve closes to prevent blood from flowing back into the ventricle.

The veils

The leaflets form the physical and hemodynamic boundary between the left
ventricle and the aorta. Structures distal to them are subject to arterial pressures,
while those proximal to them are subject to ventricular pressures. The tricuspid
design represents the optimal solution to achieve maximum valve opening with
minimum resistance.

https://cirugiacardiacamalaga.e
s/anatomia-valvula-aortica/
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Ring
The insertion of the leaflets into the wall of the aorta forms a crown-shaped
structure of firm fibrous tissue that is normally called the “aortic ring.” This
term is not entirely correct in suggesting a circular shape but is sanctioned
by the use. We can refer to it as a ventriculo-aortic junction or as a basal
ring, although a discussion about the appropriateness or not of these terms
is beyond our purpose.
Intercommissural triangles
They are the triangles that exist below each commissure, their base being
formed by the line that joins the nadirs of adjacent velums and their apex by
the sinotubular junction.
Sinotubular junction
It separates the root from the ascending aorta or tubular aorta and is the line
that joins the commissures.
Sinuses of Valsalva
They are the three bulges of the aortic wall that make up the root. Coronary
arteries arise from two of them and are therefore called right, left and non-
coronary coronary sinuses. Its proximal limit is formed by the insertions of
the leaflets and its distal limit is formed by the sinotubular junction.

https://cirugiacardiacamalaga.es/
anatomia-valvula-aortica/

Instrumental
Extracorporeal basket adult
2 HB #15 - 11
coronary team
sternal separator
Aortic gauge set
vacuum cleaners
Institutional accessories
basket
Aortic valve reimplantation
Rigid type pericardium
aspirator
Aortic or arterial cannulas
oscillating saw
Engine
pacemaker alligators
Reamer Accessory Clamp
wire cutting
Rigid type pericardium
aspirator
SURGICAL INSTRUMENTATION PROGRAM
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Supplies Sutures Solutions
Disposable clothing package Precut silk Saline solution
Polyester kit y-31 2/0 Bupivacaine 0.5% with
Electroscalpel Vascular cutting needle epinephrine
Suction rubber Bone wax
Sharps container Poliglactin 910 0 CT-1
Aseptosyringe needle ½ circle
Pleurovac Polyester round needle
Gauze containers 2/0 ½ circle
Radiopaque gauze Silk 0, needle ½ circle
20 cc syringe Polypropylene 4/0 rb1
Yankawer cannula needle ½ circle
Gloves Surgical wire
Compresses Monocryl 3/0 sharp 3/8
Micropore needle
Handlebars
Nelaton 8 and 14 probe
Pathology Flask
Aortic valve implant
Qosina Connector
Ioban surgical field
Three way key
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MAY TABLE
1. MB # 7 HB# 15
2. MB #7 HB# 15
16 17 3. May scissors
4. Metzenbaum scissors
15
8 5. Straight kelly fórceps
11
6. Curved Kelly Forceps
9
7. Curved Mosquito Tweezers
10 18
8. Protected Curved Mosquito Tweezers
7
9. Kelly adson clamp
6 12 13
10. Kocher fórceps
14
11. Tube clamp
5 4 12. Farabeuf Separators
13. Vascular Dissections
2 3 14. Metzenbaum long scissors
1 15. Container with lid for sharps material
16. Backhaus Froceps
17. Gauze
18. Tourniquet with guide
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RESERVATION TABLE

18 16
2 22
37
21 6 36
27

19
23 14
1
17 15
20

24 28 7 5
31
26

8
33
30

25
13 11 10 3
12 9
32
35 34 4

1. Disposable clothing package 10. Wire cutter 19. Debakey Clamp

2. Extracorporeal basket 11. Lister scissors 20. Rigid pericardium aspirator
3. Barren fields 12. Vascular needle holder Allix clamp 21. Yankauer cannula
4. Reciprocating saw 13. Normal needle holder 22. Coke
5. Alligators for pacemakers 14. Claw and non-claw dissections 23. Pathology Flask
6. Accessory kit 15. Allix clamp 24. Sutures
7. Sterile gloves 16. Vascular Dissections 25. Nelaton probe #8 - #14 FR
8. Sternal separator 17. Cushing separator 26. Coronary perfusion cannula
9. Wire needle holder 18. Nerve hook 27. Vent vacuum cleaner
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28. Connectors 35. Suction rubber

29. Single venous cannula 36. Electroscalpel

30. EOPA #20 FR 37. Compreses

31. Gauze container

32. 20 cc syringe
33. Asepto Syringe

34. Cardioplegia line

PATIENT POSITIONING AND TYPE OF ANESTHESIA

Decubitus Supine
And
General
anesthesia
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POSITIONING OF THE SURGICAL TEAM

6
1. Surgeon
1 2. Surgical assistant
3 4 3. Surgical instrument
4. Surgical instrumentation
student
5. Perfusionist nurse
6. Anesthesiologist
7. Nursing assistant

5
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TYPE OF INCISION: STERNOTOMY

SURGICAL TECHNIQUE

PROCESS INSTRUMENTAL

Once the patient is anesthetized and dressed, the Ioban

surgical field is placed in the incision area.

It begins by making a sternotomy incision We use MB #7 HB#15

Subcutaneous cellular tissue is incised in the thorax
until reaching the sternum.
Sternotomy is performed
We perform hemostasis on the sternum
Protection of the sternal bone is then performed
Sternal separation is performed
We use electroscalpel, farabeuf separator, suction
rubber with Yankee cannula
For this we use the reciprocating saw
We use an electroscalpel and a Yankee cannula with
suction rubber.
We use bone wax and place sternum protectors
For this we use sternum separator

TRAINING SURGICAL PLANNING
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The pericardium is then elevated for complete
visualization of the heart, especially the ascending
aorta, and an incision is made.
Vascular time steps are performed
The purse string is performed in the aorta artery
Clamping of the right atrium is performed
Next we perform a purse string in the right atrium
The position of the aortic cannula is made and it is
connected to the arterial perfusion line
The single venous cannula is positioned and connected
to the venous perfusion line.
The vent cannula is positioned in the vein right upper
lung
In this part the perfusionist is informed to enter the
pump
The aorta artery is then clamped.
Se realiza incisión de la aorta para acceder a los | Tijera
de metzembaum, pinzas de disección
ostium coronarios
The coronary ostia are located and cardioplegia is
applied
SURGICAL INSTRUMENTATION PROGRAM
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We use electroscalpel, suction rubber with Yankee
cannula, silk 0 needle 1/2 circle and May scissors
We use 2/0 polyester without plush, thread tourniquet
kit, May scissors and curved kelly clamp
We use Debakey clamp
We use 2/0 polyester without plush, tourniquet kit, May
scissors and curved kelly clamp
We use MB 7 blade 11, EOPA 20 cannula, tourniquet
kit, pre-cut silk 1, May scissors, tube clamp, compress,
small coca,
rigid pericardial suction, wet compress, arterial perfusion
line
Vascular dissection forceps, Metzenbaum scissors,
32/40 single venous cannula with 1/2 -1/2 connector,
Tomiquette Kit, 1 pre-cut silk, venous perfusion line
Vascular Dissection Forceps MB 11 Adson Kelly
Forceps Vent 16 Cannula Tourniquet Kit Curved Kelly
Forceps Perfusion Suction Line
Debakey occlusion clamp
We use long Metzenbaum scissors and vascular
dissection
Spencer cannula 90” with cuisine, perfusion
cardioplegia line

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Correction time steps are performed
Aorta repair is performed
The damaged aortic valve is removed
The measurement of the new valve is carried out and it
is determined that the measurement is Z0=27.6, Z-
2=21.0, Z+2= 36.5, deciding to install a St.jude
biological valve
The position of the biological valve is made where the
natural aortic valve was located and it is tied.
Valve testing is performed
The aorta is sutured
Aeration is carried out
Position of the pacemaker wire and incision and points
for chest tube are made.
It comes out of the pump, it is unclamped and
decannulated, tying the tobacco bags
Removal of the sternal separator and final hemostasis
of the sternum separators is performed.
The sternal separator is positioned and the chest tube is
positioned in the ostomy incisions, the pleuroback is
prepared and the pads are counted.
SURGICAL INSTRUMENTATION PROGRAM
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Vascular forceps, 4/0 silk, curved mosquito forceps
Vascular forceps, Metzenbaum scissors, coke with
saline solution, wet compress, pathology bottle
Biological valve gauges #25 and #27 are used and
valve #27 is chosen
Accessory fields, mechanical valve #27 St.Jude, valve
positioner, to fix it Y-31 polyester kit double needle,
curved kelly forceps, Mayo scissors, aseptosyringe with
saline solution, MB 7 HB 11
We use the valve tester
4/0 polypropylene with double needle, vascular
dissection, vascular needle holder, May scissors, 20cc
syringe with solution
We use 4/0 polypropylene 1/2 round circle needle
2/0 pacemaker thread, vascular needle holder, 2/0
polyester, MB 7 HB 15, electro scalpel, May scissors
Removal of total occlusion clamp, MB 11, vascular
dissection forceps, saline solution, Mayo scissors
We removed the sternal retractor and sternum
protectors, and used electroscalpel and remaining bone
wax.
Sternal separator, Kocher clamp, chest tube, 14fr
Nelaton probe, suction rubber, knotting of polyester
sutures and compresses
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Sternal separator is removed and sternum suture is
performed.
Washing and infiltration
Subcutaneous cellular tissue and skin are sutured
The ioban is removed, the wounds are cleaned and
tegaderm is placed
Compresses, wire holder, surgical wire 6, wire cutter,
Kocher forceps
Aseptosyringe, suction, dry compress, 20cc syringe with
bupivacaine + hypodermic needle
We use Poliglactin 910 0 needle 1/2 round circle,
Monocryl 3/0 needle 3/8 cutting circle, claw dissection,
May scissors
Saline solution and tegaderm

BIBLIOGRAPHY

http://crvalvular.com.ar/valvula-aortica/anatomia-aortica/
https://cirugiacardiacamalaga.es/anatomia-valvula-
aortica/#:~:text=La%20v%C3%A1lvula%20a%C3%B3rtica%20es%20una,a%20%C3%A9sta%20del%20ventr%
C3%ADculo%20izquierdo.
https://es.slideshare.net/FranciscoSosa6/valvula-aortica-evaluacion-ecografica
https://www.cirugiacorazon.com/que-operamos/cirugia-valvular/cirugia-de-la-valvula-aortica/

WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES
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STUDENT SIGNATURE: KAREN DANIELA BAUTISTA TEACHING SIGNATURE: __________________________

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