Cardiovascular Surgery Mitral valve replacement

Mitral Valve Replacement (MVR)

Objective

•   To open chest

•   To expose heart

•   To replace the mitral valve.

Position

•   Supine, left semilateral

•   Catheterization

•   Cleaning and draping.

Anesthesia

General, endotracheal.

Procedure

   1.  Sternotomy—skin incision with No. 4 BP handle with No. 20 blade. Rake for holding the skin. Saw and cable for sternotomy.

   2.  Pericardiotomy—pericardiotomy with cautery.

   3.  Pericardial stay 1-0 or 2-0 Atro silk.

   4.  Aortic purse string 3.0 T3 single arm suture (2), followed with snugger and clamped.

   5.  SVC purse string and cannulation—Cooley clamp, scissors for opening the IVC 4/0 CII. S/A followed with snugger and snap.

   6.  Insert IVC cannula, remove the Cooley clamp.

   7.  IVC purse string—4/0 CII, S/A and cannulation—Cooley clamp, open the SVC insert cannula remove the clamp silk tie.

   8.  Aortic cannulation—ready for cannula No. 11 knife for hole in the aorta insert cannula, silk tie; connect the cannula.

   9.  Connect venous lines with SVC and IVC cannula. Aortic cannulae to arterial line.

10.  Cardioplegia purse string and cannulation—cardioplegia cannula, cardioplegia cooling starts.

11.  Aortic cross clamp—after giving cardioplegia the heart stop. 11 No. knife long scissors, open the left atrium, LA retractor, mitral hook. Hang right angle for holding the valve, valve cutting scissors, to excise valve, sizer to measure the valve, take the valve holder and valve, then suture 2.0 Ethibond, LA closure 1st 3.0 Prolene No. 8 Folley’s to check the mitral valve.

12.  Decannulation IVC and SVC cannula taken out and stitched.

13.  Cardioplegia cannula is removed. Aortic cannula is also removed. Aorta stitch 4.0 T3.

14.  Pacing wires—2 pacing wire.

15.  Drainage tubes.

16.  Sponge and instruments count.

17.  Sternotomy closure.

18.  Ethibond.

19.  Muscle

20.  2.0 Vicryl.

21.  Skin 3.0 prolene.

Instruments

•   Cleaning tray

•   Catheterization set

•   Cardiac set

•   Open heart vascular set

•   Open heart special set

•   Open heart water seal.

Special Instruments

•   11 No. knife long handle

•   Nelson scissors

•   Mitral hooks 2

•   Left atrial ret.

•   Long DeBakey needle holder

•   Valve sizers and holder.

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