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  • The Aortic Valve Replacement: Basic Cardiovascular Surgery Skills

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    Teodora Georgescu
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    This document provides information on aortic valve replacement surgery. It discusses the indications for aortic valve replacement including aortic stenosis, regurgitation, endocarditis, and disease of the bicuspid aortic valve with ascending aortic disease. It describes the surgical approaches including median sternotomy, mini-sternotomy, right thoracotomy, and TAVI. The steps of the surgery are outlined including cannulation, cardioplegia, excision of the native valve, insertion and suturing of the prosthetic valve, and closure of the aorta. Postoperative management and references are also mentioned.

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    Valve

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    This document provides information on aortic valve replacement surgery. It discusses the indications for aortic valve replacement including aortic stenosis, regurgitation, endocarditis, and disease of the bicuspid aortic valve with ascending aortic disease. It describes the surgical approaches including median sternotomy, mini-sternotomy, right thoracotomy, and TAVI. The steps of the surgery are outlined including cannulation, cardioplegia, excision of the native valve, insertion and suturing of the prosthetic valve, and closure of the aorta. Postoperative management and references are also mentioned.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    7 views33 pages

    The Aortic Valve Replacement: Basic Cardiovascular Surgery Skills

    Uploaded by

    Teodora Georgescu
    This document provides information on aortic valve replacement surgery. It discusses the indications for aortic valve replacement including aortic stenosis, regurgitation, endocarditis, and disease of the bicuspid aortic valve with ascending aortic disease. It describes the surgical approaches including median sternotomy, mini-sternotomy, right thoracotomy, and TAVI. The steps of the surgery are outlined including cannulation, cardioplegia, excision of the native valve, insertion and suturing of the prosthetic valve, and closure of the aorta. Postoperative management and references are also mentioned.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 33

    THE AORTIC VALVE REPLACEMENT

    Basic Cardiovascular Surgery Skills


    AVR - Indications
    1. Aortic Stenosis
    2. Aortic Regurgitation
    3. Ao valve endocarditis
    4. Bicuspid Ao valve + disease
    of the ascending Ao
    What valve?

    rarely contraindicated:
    - premenopausal women
    - unusual risk of hemorrhage (severe peptic ulcer
    disease, ulcerative colitis, or hazardous
    occupation) or hemolysis
    What valve?
    - over age 70, particularly those in sinus rhythm (survival
    benefit with bioprosthetic valves over mechanical valves
    in this age group)
    - reoperation rates are currently low for patients over 65
    years of age
    - only under unusual circumstances in persons younger
    than 45 (because of rapid SVD in this age group)
    *Special situations

    Apico-Ao
    Wheat Bentall conduit
    AVR – Approaches
    1. Median sternotomy
    2. Ministernotomy
    3. Right thoracotomy
    4. TAVI*
    AVR – Approaches

    Ministernotomy
    AVR – Approaches

    Full sternotomy
    ... After sternotomy

    Pericardium opening
    Preparing for CPB
    Heparine- IN → Cannulation
    Ao cannulation Right atrial cannulation
    Bypass ON...
    Ao cross clamp ON...

    Cardioplegia - ON
    I’m cold
    and empty
    inside
    Aortotomy
    A little anatomy
    Native valve excision and annulus
    debridement
    Stay sutures

    and aortic ring sizing


    (*ppm)
    ... different suturing manners
    Sutures placing on the valve
    Sutures complete → valve seated

    ...and careful knot tying.


    Valve tied-down... final check...

    ...time to start closing.


    Closing the aorta:
    • Vent – OFF
    • Careful heart de-airing !!!
    • → Tie down the first layer of suture
    • Ao cross-clamp – OFF
    • Secure Ao closure with a second layer
    What next ...?

    WERE YOU FAST


    ENOUGH ?
    • HEART – back ON (rhythm?)
    • Gradually lower CPB flow
    • BYPASS – OFF
    • Remove cannulas
    • Protamine - IN
    • Haemostasis, aspirative drains
    Time to finish
    References
    1. Guidelines on the management of
    valvular heart disease (version 2012).
    European Heart Journal (2012) 33, 2451–
    2496; doi:10.1093/eurheartj/ehs109
    2. Khonsari - Cardiac Surgery Safeguards
    and Pitfalls in Operative Technique, 4th
    Edition (2008)
    3. Kirklin, Barratt-Boyes - Cardiac Surgery,
    4th Edition (2013)

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