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AUGUST 2015 | The Surgical Technologist | 355 the cardiothoracic surgeons, cardiologists and echo car- diologist, the valve will be deployed using an insufflation device with a pre-measured amount of contrast medium/ NaCl. Once the valve is deployed, the contrast medium/ NaCl will be aspirated from the balloon using the same insufflation device and the rapid pacing is stopped. The delivery catheter will be removed from the aorta, and the valve placement will be evaluated by angiogram and TEE. A collaborative reading will be performed by the car- diothoracic surgeon, cardiologist and an echo cardiologist to determine adequate placement and possible valvular or paravalvular leaks. At this time, the cardiothoracic surgeon will remove the delivery catheter and place an angled Debakey vascular clamp across the femoral artery. The femoral arteriotomy will be closed using Stille forceps and multiple 5-0 polypropylene sutures. The incision will be irrigated with antibiotic irrigation, and the surgical technologist and the circulating nurse will perform the final count. The first fascial layer is closed with interrupt- ed 0 polylactic acid sutures. The second facial layer will be closed with a running 2-0 polylactic acid suture and the skin will be closed with a running 3-0 poliglecaprone 25 suture. The incision site will be covered with a layer of liquid adhesive and a transparent dressing with chlorhexi- dine gluconate. The pigtail catheter and internal pacing wire will be removed by the cardiologist as well as the 6 French sheaths. The cardiothoracic surgeon will remove the 6 French sheath and extra stiff .035-inch wire that was placed as an access point in case cardiopulmonary bypass was needed. For vessels not closed with suture, the manual pressure or closure device will be utilized. The patient is usually extubated and transported to the cardiac intensive care unit. However, there are times when a patient might need to remain intubated and then will be transported to the cardiac intensive care unit to be extubated at a later time. C OMP L I C A T I ONS As with any surgical procedure there are always risks. Immediate complications include aortic rupture and tam- ponnade, a valve issue such as malposition or leakage, stroke, myocardial infarct from coronary ostium inter- ference and access route trauma such as iliac artery tear. Some of these can be lethal and necessitate the insertion of an intraaortic pump counterpulsation and even prompt a sternotomy and extracorporeal bypass. Other postopera- tive complications include respiratory failure, renal failure and infections. RECOV ERY The average hospital stay is two to three days and patients are encouraged to start walking the day following the procedure. Pain medication will be prescribed as necessary. A follow-up appointment will be made to make sure wound site is healing properly, which generally takes as long as two weeks to heal. Cardiac rehabilitation will be scheduled and most patients return to normal activities within one to two months after surgery. A BOU T T HE AU T HOR Ryan Parker, CST, CSFA, has been a Certified Surgical Technologist for eight years and recently achieved the creden- tials of Certified Surgical First Assistant. She resides in New Boston, New Hamp- shire, and currently works as part of the CVOR team at Catholic Medical Center in Manchester. She would like to extend a special thanks to Yvon Baribeau, MD; Benjamin Westbrook, MD; as well as her colleagues for their continued support and encouragement, and to all who had input for this article. R E F ER ENC E S 1. www.newheartvalve.com 2014, Edwards Lifesciences Corporation. 2. Seifert, PC. Cardiac surgery perioperative patient care. St Louis, Missouri. Mosby 2002. 3. Rosenhek R., et al. Predictors of outcome in severe, asymptomatic aortic ste- nosis. N Engl J Med 343(9) :611 2000. 4. Otto CM. Timing of aortic valve surgery. Heart 2000; 84: 211-218.