Articles
About
Publish
Subscribe
Sign In
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
chevron_right
a. Stitch the Pericardium to the Skin Edges Creating a Pericardial Well
6. Distal Aortic Arch Cannulation
7. Bicaval Cannulation (for Later PFO Closure)
chevron_right
a. SVC Cannulation Through the Right Atrial Appendage
b. Establish Cardiopulmonary Bypass
c. IVC Cannulation
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
chevron_right
a. Place Sutures Circumferentially Around Annulus Where the Valve was Previously
b. Carry Sutures Through the Sewing Ring of the Valve
c. Position the Valve and Tie all the Knots
18. Ascending Aorta Replacement
chevron_right
a. Prepare for Graft
b. Give Additional Cardioplegia
c. Proximal Anastomosis 2-3 mm Above the Sinotubular Junction with External Felt Support
d. Give Additional Cardioplegia
e. Excise Dilated Ascending Aorta
f. Cut Graft to Appropriate Size
g. Distal Anastomosis with External Felt Support
19. PFO Closure
chevron_right
a. Snare the SVC and IVC
b. Right Atriotomy
c. Expose and Inspect PFO
d. Close PFO
e. Close Right Atrium and Release Snares
20. De-airing Maneuvers and Reanimating the Heart
chevron_right
a. Bipolar Ventricular Epicardial Pacing Wire Placement on the Inferior Surface of the Right Ventricle
21. Reperfusion and Rewarming
chevron_right
a. Inspect Aortic Valve with Ultrasound and Start Ventilation
b. Remove LV Vent
22. Decannulation and Separation from Cardiopulmonary Bypass
chevron_right
a. Decannulate SVC
b. Repair Right Atrium
c. Decannulate IVC
d. Reverse Heparin with Protamine Sulfate and Decannulate Aorta
e. Repair IVC
23. Hemostasis
chevron_right
a. Place Chest Tubes
24. Closure
25. Post-op Remarks
jkl keys enabled
Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure
David W. Miranda, MD, MS
;
Jordan P. Bloom, MD, MPH
Massachusetts General Hospital
Tags:
Cardiology
Main Text
Procedure Outline
Transcript
Comments
Comments (0)
Subscribe to comments
LIMITED ACCESS
To gain temporary access for evaluation purposes, please:
CREATE AN ACCOUNT
OR
SIGN IN
Share This Article
Authors
David W. Miranda, MD, MS
Jordan P. Bloom, MD, MPH
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
8/8/2025
Article ID
425
Production ID
0425
Volume
2025
Issue
425
DOI
https://doi.org/10.24296/jomi/425