SURGICAL INSTRUMENTATION PROGRAM

TRAINING SURGICAL PLANNING

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STUDENT NAME: ISIS DANIELA ROJAS GELVES CODE: 01210021006 PRACTICE LEVEL: III SEVENTH SEMESTER

TEACHER'S NAME: LIDY HIGUERA PRACTICE STAGE: ICB NOTE:

SPECIALTY: CX SURGEON: DATE: FEBRUARY, 21, 2024

CARDIOVASCULAR Dr. GIRALDO

NAME OF PATIENT: MEDICAL HISTORY NUMBER: PATIENT AGE: 73 YEARS OLD

SAMUEL PLATA OREJARENA 5754987
SURGICAL PROCEDURE TO PERFORM: BIOLOGICAL AORTIC VALVE REPLACEMENT

SURGICAL INSTRUMENTATION PROCESS

1. PLANNING STAGE:

1.1. SURGICAL OBJECTIVE: Improve the symptoms that the patient has, slow the progression of the disease, preventing it from affecting other
organs and, consequently, increase the patient's life expectancy.

1.2. ANATOMY AND PHYSIOLOGY: The aortic valve is made up of three semilunar-shaped fragments of tissue (veils) that are attached to the
wall of the aorta.
Aortic sinuses
Right Coronary Sinus: it is located anteriorly and rests on the muscular septum, from which the right coronary artery arises.
Left Coronary Sinus: it is located towards the left posterior and from it, the Left Coronary Artery arises. It rests on one of its halves on the
muscular septum, and on the other on the left fibrous trigone and the intervalvular trigone.
Non-Coronary Sinus: it is located towards the right posterior and, as its name indicates, it does not
gives rise to no coronary artery. It rests on the intervalvular trigone and the membranous septum
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Aortic physiology: When the left ventricle contracts (systole),

pressure increases in the left ventricle. When the pressure in the
left ventricle rises above the pressure in the aorta, the aortic
valve opens, allowing blood to flow from the left ventricle into
the aorta. When ventricular systole ends, the pressure in the left
ventricle drops rapidly. When the pressure in the left ventricle
decreases, the aortic valve closes. Closure of the aortic valve
contributes to the second heart sound.

¿ What is aortic insufficiency?

It consists of the inability of the leaflets that form the valve to
achieve hermetic closure of the aorta, which causes blood reflux
from the aortic root to the left ventricle during ventricular
diastole. This phenomenon causes an increase in volume and
pressure in the left ventricle at the end of diastole.

What is aortic stenosis?

Aortic stenosis is characterized by abnormal narrowing of the
orifice of the aortic valve, which makes it difficult for blood to
pass and leads to higher flow rates through the valve, higher
pressure gradients, and consequently hypertrophy of the left
ventricle such as compensation. The reduction of the valve
orifice can be congenital or acquired, the latter secondary to
rheumatic fever or calcification.

REFERENCES. RA: right atrium; PA: pulmonary artery; RSC: right coronary sinus; RV: right ventricle; ncs:
non-coronary sinus.

1.3 CHECKLIST
INSTRUMENTS
Extracorporeal Basket
Accessory equipment
Dr. Giraldo sternal retractor
Reciprocating saw with battery
MOSAIC valve meters
Biological valve #27
SURGICAL INSTRUMENTATION PROGRAM
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MEDICAL DEVICES/EQUIPMENT SUTURES AND NEEDLES DRUGS AND SOLUTIONS
Disposable Cardio Clothing Pack ACIFLEX Wire Suture #6 Warm saline solution
Gauze container VICRYL Plus 0 CT-1 36.4 mm for subcutaneous tissue
Sharps container bone wax for sternum hemostasis
Handlebars PROLENE 4-0 2 RB-1 17 mm for making tobacco
Accessory fields for the skin pouches and suturing the aorta
sterile gloves MONOCRYL 3-0 PS-2 19 mm 3/8 circle for skin suture
electrosurgical pencil SILK 0 SH 26 mm to repair the pericardium
Dr. Giraldo's Restoration Clamp SILK 1 pre-cut for fixing the cannulas
Gauze (10) SILK 4-0 RB-1 17 mm to repair the aorta
Compresses (20) Suture or thread for pacemaker TEMPOWIRE 2-0 SH
suction rubber 26 mm
IOBAN surgical field Ti-Cron 2-0 Y-31 polyester suture 16 mm 16 needles
Tegaderm dressing with PTFE felt for aortic valve suture
Yankawer cannula Ti-Cron 2-0 polyester suture 25 mm 1/2 round circle
Sample bottle for arterial and venous cannulation
20 cc syringe Bupivacaine 0.5% increases to 100%
sterile micropore Fibrillar-Gelita-Cel
Pericardial aspiration cannula
Arterial cannula + guide 20 Fr EOPA
Single venous cannula of 34 - 46 Fr
Vein aspirator: for the right upper pulmonary vein
Qosina Connector
#32 and #34 Valve Ring Gauges
(2) Chest tube #34
Nelaton 14 Fr probe (To repair clamps)
#14 suction tube to aspirate chest tubes
Aseptosyringe
Accessory gown
Alligators for pacemakers
connectors for cannulas
Scalpel blades No. 11 and No. 15
Cardioplegia line
Hypodermic needle #18
Sternal protection tubes
three-way wrench
Tourniquet Kit
Polyester dressing for healing
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DERMABOND
2. Organizational stage

2.1. ARRANGEMENT OF SURGICAL TABLES

MAY TABLE LEFT

1. Scalpel handle #7 with blade #11
2. Scalpel handle #7 with blade #15
3. May scissors
4. Fine metzembaum scissors
5. Farabeuf separators
6. Vascular dissection forceps
7. Tourniquets with guide
8. Long may scissors
9. Protected curved mosquito forceps
10. Gauze
11. Container for sharps
12. Field forceps
13. Sternal protection tubes
14. Tube clamp
15. Curved Rochester clamp
16. Kocher clamp
17. Curved Kelly clamp
18. Curved mosquito tweezers
19. Straight Kelly tweezers
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RESERVE TABLE 1. Adult extracorporeal basket

2. Compresses
3. Container for gauze
4. Aseptosyringe
5. Valve suture kit
6. Coke for saline solution
7. Aciflex #6
8. #14 suction tube to aspirate chest tubes
9. Venous aspiration cannula
10. Pericardial aspiration cannula
11. Chest tube
12. Single venous cannula
13. Arterial cannula
14. tourniquet
15. 20cc syringe
16. Sutures
17. bone wax
18. sample bottle
19. coca
20. Needle holder
21. Lister Scissors
22. cut wire
23. wire needle holder
24. Sternal separator
25. connectors
26. hypodermic needle
27. nelaton probe
28. Yankawer cannula
29. coronary perfusion cannula
30. Resan tongs
31. Aorta clamp
32. hook
33. Cushing separator
34. vascular dissection forceps
35. allix tweezers
36. Skin dissection forceps
37. Needle holder for skin
38. Accessory equipment
39. sterile gloves
40. alligators for pacemakers
41. accessory leather fields
42. reciprocating saw
43. Clothing package
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2.2. Patient position

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2.3. Location of surgical equipment

1. Surgeon
2. Surgical instrumentation
3. Surgical assistant
4. Anesthesiologist
5. Extracorporeal circulation machine
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3. Execution stage
a. Type of anesthesia: General
b. Approach: anterior-Incision: sternotomy
c. Steps and instruments used in the surgical technique:
INITIAL COUNT OF COMPRESSES, GAUZE...
The surgeon begins by performing a sternotomy
Incision of the subcutaneous cellular tissue and hemostasis are made.
The surgeon makes cut of the sternum and opening of the thoracic cavity
Hemostasis of the sternum and cavity
Protection is placed on the sternum and the thoracic cavity is opened.
Dissection and elevation of the epicardium is done to expose the heart
Repair stitches are made to the epicardium to expose the heart
Repair points are made in the aorta artery for the respective arterial
cannulation
A repair stitch is made in the right atrium
A repair stitch is performed on the right superior pulmonary vein
An incision is made in the ascending aorta artery, a cannula is inserted, and
the purse string is adjusted.
#7 scalpel handle with #15 blade
Electroscalpel, compress, Farabeuf separators
Reciprocating saw, compresses
Electroscalpel, bone wax
Plastic probes, sternal separator
Fine dissecting forceps, electroscalpel
Silk 0 SH, 26 mm needle ½ round circle, May scissors, dissecting forceps and
Needle Holder
Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
Silk 4-0 RB-1 17 mm, May scissors, dissecting forceps, Needle Holder
#7 Scalpel Handle with #11 Blade, 20 Fr Aortic Arterial Cannula,
tourniquets, tourniquet guide, 1 pre-cut silk to adjust the cannula

The EOPA cannula connects to the arterial infusion cannula

An incision is made in the right atrium, a single venous cannula is inserted, #7 Scalpel Handle with #11 Blade, Venous Cannula 34-46Fr, tourniquets,
and the purse string is adjusted. tourniquet guide, 1 pre- cut silk to adjust the canula
They put a cannula to aspirate the right upper pulmonary vein vein aspirator
The cardioplegia tube is purged cardioplegia cannula
Patient is started on an extracorporeal circulation machine pump
The aorta is clamped after the probe is placed near the root of the aorta. Bakey aorta clamp
The aorta artery is cut and all possible blood is aspirated Vascular dissection forceps, 7 scalpel handle with 11 blade, pericardium
aspiration cannula
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Cardioplegia is passed through the left coronary artery and then through the
right coronary artery.
Repair stitches are made to the aorta
The patient's Pump time begins and the heart becomes asystole, and total
clamping of the aorta is performed in the middle of the two cannulas.
Surgeon finds traces of endocarditis in aortic and mitral valve
The semilunar valves of the aorta that are damaged are cut, a perforated one
was observed and it is delivered for laboratory culture of the same.
The aortic valve is measured to determine its respective replacement valve.
Placement of clean accessory fields around the surgical wound
Soak and prepare the aortic valve for 60 seconds
Coronary perfusion cannula, 1000 cc cardioplegia bolus
SILK 4-0 RB-1 17 mm, vascular dissection forceps, needle holder, long mayo
scissors, straight Kelly forceps for suture repair
Bakey Clamp
Vascular Dissection Hook and Forceps
Long mayo scissors, long dissection forceps, bottle to take the sample
Mosaic Aortic Valve Gauges #25 and #27
skin fields
Clean coke, saline solution and valve holder

Aortic valve #27 is passed to surgeon to be sutured Ti-Cron 2-0 Y-31 polyester suture 16 mm, long needle holder, May scissors
The right side is sutured first and then the left.
Culture is delivered to the nursing assistant
All the sutures of the aortic valve are finished Aseptosyringe, needle holder, long May scissors and Ti-Cron 2-0 Y-31
polyester suture 16 mm
The valve is lowered and located at the root of the aorta and each suture Aseptosyringe, May scissors
begins to be tied.
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It is decided to place the #34 valve ring, starting by suturing from the edges
The base of the implanted valve is checked to see that there are no leaks,
adjustment points are placed.
Valve protector removed, It is checked that it is in good condition,
hemostasis is checked
The aorta artery is sutured with internal and external suture
The patient is placed in the Trendelenburg position and cardiac massage is
performed.
The aorta is unclipped
Pacemaker wire is placed in the left ventricle
Needle holder, Ti-Cron polyester suture 2-0 Y-5 26 mm
Needle holder, Ti-Cron 2-0 polyester suture 25 mm, long scissors,
Aseptosyringe
#7 scalpel handle with #11 blade
PROLENE 4-0 2 RB-1 17 mm, Needle holder, long scissors, syringe asepto
Suture or thread for pacemaker TEMPOWIRE 2-0 SH 26 mm

The black color is connected to the pacemaker suture needle and the red
color to the hypodermic needle that is placed on the patient's skin.
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After a while the heart does not recover its rhythm so another pacemaker
thread is placed on the right side.
The patient is removed from the pump
A venous cannula is removed from the pulmonary vein and said structure is PROLENE 4-0 2 RB-1 17 mm, Needle holder, vascular dissection forceps
sutured.
They remove the arterial cannula from the aorta and suture said structure PROLENE 4-0 2 RB-1 17 mm, Needle holder, vascular dissection forceps
Administer protamine to the patient to reverse the effect of heparin
Hemostasis is checked
The epicardium repair stitches are removed, hemostasis is checked. Mayo scissors, Yankawer cannula and dissecting forceps
The heart is checked to beat again, the patient's vital signs are checked
The tube is passed to the chest in the mediastinum, an incision is made in the #34 chest tube, Kocher clamp, #7 scalpel handle with #15 blade, compress
xiphoid process.
A second tube is passed to the chest but located in the right pleura.
Sternal separator is removed, final count is done before closing the sternum Aciflex #6, Wire needle holder, wire cutter
Closure is done: first suture the sternum and then the subcutaneous cellular Curved Rochester forceps, #6 wire suture, wire cutter, wire needle holder
tissue, the patient's tissue is infiltrated Syringe with 0.5% bupivacaine taken to 100%
Fine Needle Holder, VICRYL Plus 0 CT-1 36.4mm, Clawless Dissecting
Forceps, Short May Scissor, Compress
skin suture Fine needle holder, MONOCRYL 3-0 PS-2 26 mm,
dissecting forceps with claw
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Cleaning the surgical wound, placing a dressing, cleaning the patient, Compress, saline solution, DERMABOND, gauze, dressing and transparent
removing the surgical field IOBAM fixomull
Removal of fields and arrangement of instruments
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WEEKLY REPORT FORMAT OF TRAINING PRACTICE

SURGERY ASSISTANCE RECORD FORM - TRAINING PRACTICE IQX-FT-024-UDES
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STUDENT SIGNATURE: ISIS ROJAS TEACHING SIGNATURE: __________________________