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  • Title
  • 1. Introduction
  • 2. Midline Incision
  • 3. Midline Sternotomy with an Oscillating Saw
  • 4. Hemostasis and Heparinization
  • 5. Sternal Retraction and Pericardiotomy to Expose the Heart and Aorta
  • 6. Distal Aortic Arch Cannulation
  • 7. Bicaval Cannulation (for Later PFO Closure)
  • 8. Stop Ventilation and Place a Vent into the Left Ventricle Using the Right Superior Pulmonary Vein
  • 9. Separate Aorta from Pulmonary Artery
  • 10. Test Snares of the SVC and IVC
  • 11. Electromechanical Arrest via a Cross Clamp on the Ascending Aorta and Cardioplegia Directly into the Aorta
  • 12. Aortic Transection
  • 13. Excision of Dilated Ascending Aorta Above the Coronary Arteries
  • 14. Aortic Valve Inspection
  • 15. Aortic Valve Excision and Debridement with Extreme Care to Prevent Calcifications from Entering the Heart
  • 16. Sizing Annulus and Choosing Replacement Valve
  • 17. Aortic Valve Replacement
  • 18. Ascending Aorta Replacement
  • 19. PFO Closure
  • 20. De-airing Maneuvers and Reanimating the Heart
  • 21. Reperfusion and Rewarming
  • 22. Decannulation and Separation from Cardiopulmonary Bypass
  • 23. Hemostasis
  • 24. Closure
  • 25. Post-op Remarks

Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure

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David W. Miranda, MD, MS; Jordan P. Bloom, MD, MPH
Massachusetts General Hospital

Cardiac Surgery

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Midline Incision
      1. 3. Midline Sternotomy with an Oscillating Saw
        1. 4. Hemostasis and Heparinization
          1. 5. Sternal Retraction and Pericardiotomy to Expose the Heart and Aorta
            1. 6. Distal Aortic Arch Cannulation
              1. 7. Bicaval Cannulation (for Later PFO Closure)
                1. 8. Stop Ventilation and Place a Vent into the Left Ventricle Using the Right Superior Pulmonary Vein
                  1. 9. Separate Aorta from Pulmonary Artery
                    1. 10. Test Snares of the SVC and IVC
                      1. 11. Electromechanical Arrest via a Cross Clamp on the Ascending Aorta and Cardioplegia Directly into the Aorta
                        1. 12. Aortic Transection
                          1. 13. Excision of Dilated Ascending Aorta Above the Coronary Arteries
                            1. 14. Aortic Valve Inspection
                              1. 15. Aortic Valve Excision and Debridement with Extreme Care to Prevent Calcifications from Entering the Heart
                                1. 16. Sizing Annulus and Choosing Replacement Valve
                                  1. 17. Aortic Valve Replacement
                                    1. 18. Ascending Aorta Replacement
                                      1. 19. PFO Closure
                                        1. 20. De-airing Maneuvers and Reanimating the Heart
                                          1. 21. Reperfusion and Rewarming
                                            1. 22. Decannulation and Separation from Cardiopulmonary Bypass
                                              1. 23. Hemostasis
                                                1. 24. Closure
                                                  1. 25. Post-op Remarks
                                                    1. Stitch the Pericardium to the Skin Edges Creating a Pericardial Well
                                                    1. SVC Cannulation Through the Right Atrial Appendage
                                                    2. Establish Cardiopulmonary Bypass
                                                    3. IVC Cannulation
                                                    1. Place Sutures Circumferentially Around Annulus Where the Valve was Previously
                                                    2. Carry Sutures Through the Sewing Ring of the Valve
                                                    3. Position the Valve and Tie all the Knots
                                                    1. Prepare for Graft
                                                    2. Give Additional Cardioplegia
                                                    3. Proximal Anastomosis 2-3 mm Above the Sinotubular Junction with External Felt Support
                                                    4. Give Additional Cardioplegia
                                                    5. Excise Dilated Ascending Aorta
                                                    6. Cut Graft to Appropriate Size
                                                    7. Distal Anastomosis with External Felt Support
                                                    1. Snare the SVC and IVC
                                                    2. Right Atriotomy
                                                    3. Expose and Inspect PFO
                                                    4. Close PFO
                                                    5. Close Right Atrium and Release Snares
                                                    1. Bipolar Ventricular Epicardial Pacing Wire Placement on the Inferior Surface of the Right Ventricle
                                                    1. Inspect Aortic Valve with Ultrasound and Start Ventilation
                                                    2. Remove LV Vent
                                                    1. Decannulate SVC
                                                    2. Repair Right Atrium
                                                    3. Decannulate IVC
                                                    4. Reverse Heparin with Protamine Sulfate and Decannulate Aorta
                                                    5. Repair IVC
                                                    1. Place Chest Tubes

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                                                    Authors

                                                    Filmed At:

                                                    Massachusetts General Hospital

                                                    Article Information

                                                    Publication Date
                                                    Article ID425
                                                    Production ID0425
                                                    Volume2025
                                                    Issue425
                                                    DOI
                                                    https://doi.org/10.24296/jomi/425