421 - Aortic Valve Replacements

Equipment Bed warmer Suction machine Cell-saver machine Electrosurgery Unit (ESU) Fluid warmer and slusher Cardiopulmonary bypass machine saline. The CST rinses the valve for 10 seconds, or per manu- facturer’s instructions, in one basin, and then rests the valve in the second basin until it is needed. The surgical assistant holds the valve for the surgeon, who sews the polyester sutures into the replacement valve. With each third of the valve annulus, the surgeon takes one hemostat to wrap the suture around, and another hemostat to clamp the suture near the needles, which the CST will cut and place in the needle holder.When finished, the CST squirts the suture with cold saline so the valve slides down easily. The surgeon ties the sutures to secure the valve into place and cuts the sutures. Using two 4-0 polypropylene pledgeted sutures on RB-1 Instruments Hemostats Sternal saw Wire cutters Freer elevator Needle holders Sternal retractor Aortic retractors Pituitary rongeur Aortic valve sizers Rumel tourniquets Aortic cross clamp Backhaus towel clamps Small and large tube clamps Nickel plate with tube holders Metzenbaum scissors (short and long) #3 (short and long) and #7 knife handles Forceps (long and short Debakeys, Russians, Ferris-Smiths, Adsons) Supplies Bone wax Chest tubes Sternal wires Sterile water Specimen cup Sternal saw blade Red rubber catheters Open-ended suction tip Gabby-frater suture guides 0.9% IV saline for warmer and slusher Absorbable and non-absorbable sutures Arterial, venous, retrograde and antegrade cannulas for cardio-pul- monary bypass Open heart pack that includes: laparotomy sponges, Ray-tec spong- es, towels, #10, #11, #15 knife blades, ventricular pacing wires, suture boots, cross-clamp inserts, various basins and dressings needles, each followed by a free pledget, the surgeon closes the aorta. The surgeon removes the antegrade, retrograde and LV vent cannulas and closes each site with the stitches already in place. The surgeon asks the perfusionist to stop bypass. Next the surgeon removes the venous cannula and ties that site off. The CST submerges the venous cannula in saline for the perfusionist to refill the venous line, and the CST clamps it. Once all blood volume is returned to the patient, the surgeon removes the arterial cannula and closes the site. The surgeon removes the sternal retractor, checks for bleeding with the help of the surgical assistant and places 32 French angled and 36 French straight chest tubes in the right pleural and mediastinal spaces, respec- JANUARY 2019 | The Surgical Technologist | 17