Aortic valve substitute is conventionally done thru a median sternotomy, meaning the incision is made by using cutting through the breastbone (sternum). Once the protective membrane around the coronary heart (pericardium) has been opened, the affected person is cannulated (aortic cannulation by using a cannula located on the aorta and a venous canulation by a single atrial venous cannula inserted through the right atrium). The patient is put on a cardiopulmonary bypass device, also known as the coronary heart–lung gadget. This gadget breathes for the patient and pumps their blood round their body at the same time as the healthcare professional replaces the heart valve.
Once on cardiopulmonary skip, the patient’s heart is stopped (cardioplegia). This can be executed with a Y-type cardioplegic infusion catheter located on the aorta, de-aired and linked to the cardiopulmonary skip machine. Alternatively, a retrograde cardioplegic cannula may be inserted at the coronary sinus. Some surgeons also choose to area a vent inside the left ventricle through the proper advanced pulmonary vein, because this helps to prevent left ventricular distention before and after cardiac arrest. When the set-up is prepared, the aorta is clamped close with a pass-clamp to forestall blood pumping thru the coronary heart and cardioplegia is infused. The health care provider incises the aorta some milometers above the sinotubular junction (simply above the coronary ostia, wherein the coronary arteries be part of the aorta) – a process called aortotomy. After this, cardioplegia is added immediately thru the ostia.
The coronary heart is now still and the surgeon gets rid of the affected person’s diseased aortic valve. The cusps of the aortic valve are excised, and calcium is eliminated (debrided) from the aortic annulus. The health practitioner measures the dimensions of the aortic annulus and suits a mechanical or tissue valve of the ideal length. Usually the valve is fixed in region with sutures, even though a few sutureless valves are available. If the patient’s aortic root could be very small, the sutures are placed outdoor of the aortic root as opposed to at the annulus, to benefit a few extra area.
Once the valve is in place and the aorta has been closed, patient is placed in a Trendelenburg role and the coronary heart is de-aired and restarted. The affected person is taken off the cardiopulmonary bypass device. Transesophageal echocardiogram (an ultrasound of the coronary heart finished via the esophagus) can be used to verify that the brand new valve is functioning well. Pacing wires are generally installed area, so that the heart may be manually controlled have to any complications arise after surgical operation. Drainage tubes are also inserted, to empty fluids from the chest. These are generally removed within 36 hours, at the same time as the pacing wires are normally left in vicinity till proper earlier than the patient is discharged from the clinic.