Ascending Aorta Replacement Surgery

An ascending aorta replacement was performed by Dr. Merrick on a 53 year old female with an enlarged aortic valve. A sternotomy was performed and the patient was put on a cardiopulmonary bypass, as seen in the mitral valve replacement. The sternotomy, performed to get access to the heart, can be dangerous- I was told the aorta was accidently cut through during this procedure the other day. The medical team worked quickly together to suture the hole in the aorta, as well as prepare the bypass through the femoral artery in the mid-thigh (where a great deal of blood is pumped through to get oxygenated blood to the lower body), instead of using the ruptured aorta. 

The incision made into the heart was at the location of the ascending aorta, above the sinotubular junction and below the aortic arch. Blood enters the annulus through the aortic valve coming from the left ventricle. The aorta carries oxygenated blood from the heart to the rest of the body for gas exchange within the cells.

Stenosis is a narrowing in the aorta (as shown above). Instead this woman's case was different, the aortic valve was larger than normal and in need of a replacement. The aorta was cut through (as shown in figure B). The destroyed tissue was removed with scissors, leaving two flaps on each side called pericardial patches (shown in figure D as dotted lines near the bottom of the aorta). These flaps were used to eventually suture the prothetic valve tighter into the aortic orifice. Sutures were laced on the exterior edges of the aortic orifice to pull in the new aortic prosthesis (as shown in figure C and D). A hole is made by burning each side of the prothesis tube to make an entrance for the right and left coronary arteries to enter.

Every time a prosthesis is used, it must be opened as a new package. Usually the medical device reps are in the OR ready to open the prosthesis for use in surgery. Today the nurse miss-understood the surgeon and opened a new prosthesis that wasn't the right size. It was a $5,000 mistake.

After the heart-lung machine was disconnected and the heart began to beat again on its own, there was an obvious leak of blood from a hole in the aorta from behind. There was no easy way to push the heart out of the cavity and suture the hole, but eventually it was found and fixed. We were lucky not to have had to go back onto bypass because it would have taken at least two more hours. 

I was really lucky to have had the chance to observe my first surgery with my very smart and beautiful best friend, Anja Strehlow. She works as a Physicians Assistant in cardiothoracic and previous PA in my former orthopaedic surgery department. She has always been an inspiration to me in the medical field and has supported me in reaching my goals in all aspects of my life. Tomorrow I'm even more excited to be there to watch her do her thing as she removes the coronary artery from the lower leg for a coronary bypass surgery.