Cardiovascular Surgery Aortic Valve replacement

Aortic Valve Replacement (AVR)

Objective

•   To open chest 

•   To expose the heart 

•   To replace the aortic valve. 

Position

•   Supine

•   Catheterization

•   Cleaning and draping.

Anesthesia

General, endotracheal. 

Procedure

   1.  Sternotomy—skin incision with No. 20 blade.

   2.  Saw and cable for sternotomy.

   3.  Pericardiotomy—pericardiotomy with cautery. 

   4.  Pericardial stay 0 1.0 or 2.0 atro silk. 

   5.  Aortic purse string 3.0 T3 single arm suture (2). 

   6.  SVC purse string and cannulation—Cooley clamp, open the SVC insert cannula, remove the clamp, silk tie, connect with venous line. 

   7.  Aaortic cannulation—insert cannula connect the cannula, Bypass on. 

   8.  Cool the patient.

   9.  Aortic cross clamp—No. 11 knife Pott’s for opening the aorta. 

10.  Perfuse left and right coronary. 

11.  Mayo retractor. 

12.  Aortic valve stay 2.0 Ethibond 1/2 pieces. 

13.  Valve is excised. 

14.  Sizer used to measure.

15.  Valve fixed with holder and implanted 2.0 ethibond
17 mm 1/2. 

16.  Closing the aorta 4.0 prolene 3 sutures. 

17.  Cardioplegia cannula for air removal.

18.  Decannulation.

19.  Drainage tubes.

20.  Sponge and instruments count.

21.  Sternotomy closed No. 5 Ethibond.

22.  Muscle 2.0 Vicryl.

23.  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

•   Mayo’s retractor

•   Coronary cannulae (perfusion) 

•   Valve sizer and holder.

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