Smb77
New
I need some help with this one as I'm still learning CV surgery procedures.....I don't know if 33863 or 33411 would be best coded for this along with 33620 for cannulation. Am I on the right track??
Operation:
emergent/salvage AVR #23 Edwards inspiris
debridement and patch of aortic root abscess
root reconstruction/root enlargement with Dacron patch
right femoral arterial line
right femoral venous cannulation
right IJ cannulation 20 Femflex
sternal plating with KLS Martin
Repair Aortic Valve
Technique:
It was an emergent salvage situation - patient was intubated (fio2 100% peep 10), septic and with ards.
GETA induced (Pt already intubated).
R IJ 20 Femflex was place with US and TEE guidance (heparin drip running until heparinized and connected to CPB).
Right femoral arterial line was placed with US guidance (and Seldinger technique and micropuncture).
Right femoral venous line was placed with US guidance (and Seldinger technique and micropuncture).
Sternotomy was performed. Pericardium was opened. Pericardial stays were placed.
Heparin was given for ACT > 480 which was maintained throughout the case.
Aorta cannula was placed. Femoral venous cannula was placed with TEE guidance into the SVC. Root vent was placed. Retrograde cannula was placed.
Another venous return limb was placed and connected to the RIJ Femflex.
Full bypass was initiated now with Bicaval cannulation.
LV vent was placed via RSPV.
The aorta was dissected off the PA.
XClamp was applied to distal ascending aorta (as close as possible to the hemiarch) - Del Nido cardioplegia was delivered every 60 minutes (antegrade, retrograde, and ostial).
The aorta was opened with an oblique incision.
The valve was exposed. It was debrided with scissors.
Root abscess (non coronary sinus) was debrided and patched with pericardial pledgets.
The aortotomy was cut down to the mid non coronary sinus (nicks root enlargement). Dacron patch was sewn to the edges.
Valve suture were placed circumferentially (from ventricle to aorta) - without pledgets.
The annulus was sized for a 23mm tissue valve.
The sutures were placed into the sewing cuff. The valve was seated. The sutures were secured with cor knots.
The aortotomy closure was completed with the Dacron patch thus completing the root enlargement.
The heart was de-aired. The XClamp was removed.
Hemostasis was assured.
Vents were removed.
The patient was weaned off CPB. PW/CT placed.
Patient was decannulated.
Protamine was given. Hemostasis was achieved again.
Right femoral venous line was removed and pressure held until hemostatic.
The sternum was closed with 8 wires.
3 plates were used and screwed in place (with KLS Martin system).
The soft tissue and skin were closed in layers with absorbable suture.
Operation:
emergent/salvage AVR #23 Edwards inspiris
debridement and patch of aortic root abscess
root reconstruction/root enlargement with Dacron patch
right femoral arterial line
right femoral venous cannulation
right IJ cannulation 20 Femflex
sternal plating with KLS Martin
Repair Aortic Valve
Technique:
It was an emergent salvage situation - patient was intubated (fio2 100% peep 10), septic and with ards.
GETA induced (Pt already intubated).
R IJ 20 Femflex was place with US and TEE guidance (heparin drip running until heparinized and connected to CPB).
Right femoral arterial line was placed with US guidance (and Seldinger technique and micropuncture).
Right femoral venous line was placed with US guidance (and Seldinger technique and micropuncture).
Sternotomy was performed. Pericardium was opened. Pericardial stays were placed.
Heparin was given for ACT > 480 which was maintained throughout the case.
Aorta cannula was placed. Femoral venous cannula was placed with TEE guidance into the SVC. Root vent was placed. Retrograde cannula was placed.
Another venous return limb was placed and connected to the RIJ Femflex.
Full bypass was initiated now with Bicaval cannulation.
LV vent was placed via RSPV.
The aorta was dissected off the PA.
XClamp was applied to distal ascending aorta (as close as possible to the hemiarch) - Del Nido cardioplegia was delivered every 60 minutes (antegrade, retrograde, and ostial).
The aorta was opened with an oblique incision.
The valve was exposed. It was debrided with scissors.
Root abscess (non coronary sinus) was debrided and patched with pericardial pledgets.
The aortotomy was cut down to the mid non coronary sinus (nicks root enlargement). Dacron patch was sewn to the edges.
Valve suture were placed circumferentially (from ventricle to aorta) - without pledgets.
The annulus was sized for a 23mm tissue valve.
The sutures were placed into the sewing cuff. The valve was seated. The sutures were secured with cor knots.
The aortotomy closure was completed with the Dacron patch thus completing the root enlargement.
The heart was de-aired. The XClamp was removed.
Hemostasis was assured.
Vents were removed.
The patient was weaned off CPB. PW/CT placed.
Patient was decannulated.
Protamine was given. Hemostasis was achieved again.
Right femoral venous line was removed and pressure held until hemostatic.
The sternum was closed with 8 wires.
3 plates were used and screwed in place (with KLS Martin system).
The soft tissue and skin were closed in layers with absorbable suture.