The modified Bentall procedure for aortic root replacement

AORN Journal,  July, 2006  by Cecile Cherry,  Starla DeBord,  Carol Hickey

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When the volume in the CPB machine is infused, the surgeon removes the inferior vena cava cannula and ties down the purse-string suture. The surgeon examines all the cannulation sites as well as the anastomoses sites for bleeding. If no repairs are needed, he or she closes the patient's chest using #7 steel sternal wires.

The surgeon closes the fascia and subcutaneous tissue with 0 polypropylene and 2-0 polypropylene sutures respectively. He or she then closes the skin with 4-0 polydioxanone suture. The RNFA applies a sterile dressing over the incision.

The anesthesia care provider and circulating nurse transfer the patient to the CICU accompanied by the surgeon and RNFA. During transfer, the anesthesia care provider continues to monitor the patient's electrocardiogram (ECG), arterial pressure, and oxygen saturation with a portable monitoring unit and ventilates the patient using a bag/mask device and a portable oxygen tank.

POSTOPERATIVE CARE

On arrival in CICU, the circulating nurse and anesthesia care provider report to the postanesthesia care unit (PACU) nurse who will be caring for the patient. A respiratory therapist connects the patient to the ventilator. The PACU nurse continuously monitors the patient's physiologic parameters, such as ECG, oxygen saturation, arterial pressure, and pulmonary artery pressure. He or she also monitors the patient's arterial blood gases, chest tube drainage, and urinary output. Initially, all patients are ventilated mechanically, with weaning performed as tolerated. After extubation, the PACU nurse helps the patient with using an incentive spirometer and deep breathing and coughing every one to two hours to help prevent postoperative respiratory complications.

After 24 hours in the CICU, if the patient's respiratory and hemodynamic status are stable, he or she may be transferred to the telemetry unit for the remainder of the hospitalization. If the patient had a mechanical valve implanted, the telemetry nurse starts the patient on prophylactic anticoagulation therapy when the patient is able to tolerate oral fluids and nutrition well. The telemetry nurse or a physical therapist assists the patient with progressive ambulation.

Before discharge from the hospital, the patient and his or her family members watch a videotape that explains the discharge instructions and are given the opportunity to ask any questions they may have about postdischarge care.

Discharge instructions include

* progressively increasing activity as tolerated,

* avoiding vigorous activity for 12 weeks after surgery, and

* not lifting more than 5 lbs in the first two weeks and no more than 20 lbs for three months after discharge.

If the patient received a mechanical valve, he or she will require lifelong anticoagulation therapy. The goal is to maintain the international normalized ratio (INR) for anticoagulant monitoring between 2.5 and 3.5. Normal INR in an uncoagulated patient is 1.0. (20)

The telemetry nurse instructs the patient and his or her family members in the care of the incision, which includes cleansing the incision site daily with an antibacterial soap. The nurse also instructs the patient to report to the surgeon's office immediately if he or she has any signs or symptoms of infection, including