Mitral Valve Repair - AORN

JANUARY 2007, VOL 85, NO 1Winters — ObriotFigure 3 • Placement of annuloplastyrings.Figure 4 •C-shapedmitral valveimplant.(Figurecourtesy ofEdwardsLifesciences,Irvine, Calif)support service personnel, such as purchasingand inventory stocking personnel,is essential to an efficient system.The circulating nurse also must maintaina stock of suture and be preparedto use additional suture as the procedureprogresses. Surgeon preferencesheets must be maintained and updatedto indicate the preferred annulardevices and suture.After the surgeon has exposed themitral valve apparatus, he or she opensthe patient’s left atrium using Metzenbaumscissors. The incision extends fromdistal end of the intra-atrial groove to justbelow the SVC. At this point, the surgeonplaces the mitral valve retractor using abasket and one malleable blade to exposethe annulus, leaflet tissue, or disruptedchords. He or she uses a Debakey forcepsand nerve hooks to assess the mitralleaflets and chords and to plan the repair.The surgeon looks forredundant leaflet tissueand calcified or disruptedchords.The surgeon uses a #15blade and Jamison scissorsto dissect any leafletsor chords that need repair.The scrub personprepares the disposable suture guidesand the 2-0 braided, coated, polyestervalve suture. The surgeon performs anynecessary• leaflet repairs using a 4-0 braided,coated, polyester suture;• chordal repairs with a 5-0 monofilamentpolypropylene suture; and• chordal replacement with 4-0expanded, polytetrafluroethylene(ePTFE) suture.He or she then places the suture guides ina triangle around the mitral valve retractorand places 2-0 braided coated polyestersutures in the mitral annulus, alternatinggreen- and white-colored suture.The surgeon tags the trigone sutureswith mosquito clamps on which rubbershodshave been placed. When allsutures are placed, the surgeon sizes theannulus by measuring the anteriorleaflet from annulus to the beginning ofthe zone of coaptation. 5Choosing the appropriate annulussize is based on the theory that undersizingis appropriate for mitral regurgitationwhen it is related to left ventricularenlargement. 5 The circulating nurse confirmsthe size and type of implant withthe surgeon and delivers the implant tothe scrub person. In geometric disease, afull ring is used to reduce the size of thedilated annulus. In valvular disease,however, a C-shaped ring is used to reinforcethe repair. The scrub person placesthe annular implant on the holder andhands it to the surgeon. The surgeonplaces individual 2-0 braided, coated,polyester valve sutures in the annularring or band. One-third of the sutures are160 • AORN JOURNAL