conleyclan
Guru
Controversy on coding this report.... need another opinion. Thanks....
PROCEDURE: REPAIR OF ASCENDING AORTIC ANEURYSM WITH REPLACEMENT OF THE
ASCENDING AORTA USING A 26 MM GELWEAVE GRAFT, RESUSPENSION OF THE AORTIC VALVE AND RESIZING WITH A 26 MM GELWEAVE GRAFT AND HEMIARCH REPLACEMENT WITH A BEVELED 26 MM GELWEAVE GRAFT.
OPERATIVE NOTE: Once the patient was brought to operative suite, she was
prepped and draped in sterile fashion. A sternotomy was made. The patient
was heparinized. She was placed on cardiopulmonary bypass by cannulation
of the ascending aorta distally and 2-stage venous cannula in the right
atrium, an angled SVC cannula was also placed for retrograde cerebral
perfusion. The patient was cooled to electrical _____ but during the
interval of cooling had a cross-clamp placed on the aorta at which time we
removed the ascending aorta and sent to lab after informed
consent had been obtained from the patient. Then we resuspended each of
the commissures of a trileaflet valve using pledgeted 4-0 Prolene suture
and then incised the sinotubular junction for approximately 26-27 mm. We
then selected a 26 mm Gelweave graft and sewed this at the level of the
commissures using a 4-0 Prolene suture. Once this was done, we then turned
our attention to the hemiarch replacement in which circulation was stopped.
Retrograde cerebral perfusion was initiated through the SVC cannula and
the IJ pressure was kept at less than 30 mmHg. A bevels anastomosis was
performed and the graft was then sewn to the beveled arch using a 4-0
Prolene suture. The graft was then recannulated, deaired and perfusion was
restarted. Then, during the interval of warming a graft-to-graft
anastomosis was performed with 2-0 Prolene suture and the root was vented
and the cross-clamp was removed. Over the next several minutes once
weaning criteria had been obtained, the patient was weaned from
cardiopulmonary bypass without difficulty. Protamine was administered and
all cannulas were removed. Once hemostasis had been achieved, the chest
was then closed in standard fashion. I was present for the entire duration
of this operation.
PROCEDURE: REPAIR OF ASCENDING AORTIC ANEURYSM WITH REPLACEMENT OF THE
ASCENDING AORTA USING A 26 MM GELWEAVE GRAFT, RESUSPENSION OF THE AORTIC VALVE AND RESIZING WITH A 26 MM GELWEAVE GRAFT AND HEMIARCH REPLACEMENT WITH A BEVELED 26 MM GELWEAVE GRAFT.
OPERATIVE NOTE: Once the patient was brought to operative suite, she was
prepped and draped in sterile fashion. A sternotomy was made. The patient
was heparinized. She was placed on cardiopulmonary bypass by cannulation
of the ascending aorta distally and 2-stage venous cannula in the right
atrium, an angled SVC cannula was also placed for retrograde cerebral
perfusion. The patient was cooled to electrical _____ but during the
interval of cooling had a cross-clamp placed on the aorta at which time we
removed the ascending aorta and sent to lab after informed
consent had been obtained from the patient. Then we resuspended each of
the commissures of a trileaflet valve using pledgeted 4-0 Prolene suture
and then incised the sinotubular junction for approximately 26-27 mm. We
then selected a 26 mm Gelweave graft and sewed this at the level of the
commissures using a 4-0 Prolene suture. Once this was done, we then turned
our attention to the hemiarch replacement in which circulation was stopped.
Retrograde cerebral perfusion was initiated through the SVC cannula and
the IJ pressure was kept at less than 30 mmHg. A bevels anastomosis was
performed and the graft was then sewn to the beveled arch using a 4-0
Prolene suture. The graft was then recannulated, deaired and perfusion was
restarted. Then, during the interval of warming a graft-to-graft
anastomosis was performed with 2-0 Prolene suture and the root was vented
and the cross-clamp was removed. Over the next several minutes once
weaning criteria had been obtained, the patient was weaned from
cardiopulmonary bypass without difficulty. Protamine was administered and
all cannulas were removed. Once hemostasis had been achieved, the chest
was then closed in standard fashion. I was present for the entire duration
of this operation.