DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Coronary artery disease.
2. Left ventricular dysfunction.
3. Ejection fraction, 20%.
4. Aortic stenosis.
POSTOPERATIVE DIAGNOSES:
1. Coronary artery disease.
2. Left ventricular dysfunction.
3. Ejection fraction, 20%.
4. Aortic stenosis.
OPERATION PERFORMED:
1. Coronary artery bypass grafting x1.
2. Aortic valve replacement with a #25 Medtronic Mosaic porcine heart valve.
3. Intraoperative transesophageal echocardiogram.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Stable.
INDICATIONS FOR OPERATION: This is a (XX)-year-old patient who was seen in consultation and was found to have severe aortic stenosis and recommended for aortic valve replacement. In addition, on cardiac catheterization, he was found to have single-vessel coronary artery disease and recommended for LIMA to LAD anastomosis.
DESCRIPTION OF OPERATION: The patient was prepped and draped in the appropriate manner for coronary artery bypass grafting, having undergone general endotracheal anesthetic in addition to a Swan-Ganz catheter placement. A median sternotomy incision was utilized in a standard fashion. The sternum was opened, and the left internal mammary artery was taken out with clips and Bovie cauterization. Papaverine was placed on it and the mammary artery. The vein was harvested from the leg. Then, #4-0 ties and clips were placed in the main branches. A total heparinizing dose was given. We placed the patient on cardiopulmonary bypass support and cooled to 26 degrees.
External cross-clamp was applied. Antegrade and retrograde cold blood cardioplegia was delivered. The left internal mammary artery was then anastomosed to the LAD with coalescent clips. A small bulldog was placed on the mammary artery, and it was affixed to the anterior wall with #6-0 Prolene. We then opened the aorta in a standard fashion, removed the aortic valve and decalcified the annulus. We measured for a #25 Mosaic Medtronic porcine valve. This was then tied down and positioned after appropriate sizing. Sutures were placed through it and tied down into position, closed with a running #4-0 Prolene stitch to the aorta, and the patient was given a warm hot shot of warm retro followed by warm antegrade blood cardioplegia and returned to normal sinus rhythm.
The cross-clamp was removed. Cooley needle was hooked to suction. The patient was re-warmed and weaned from cardiopulmonary bypass support without difficulty. The cannula was removed and reinforced. Mediastinum was irrigated with warm bacitracin solution. Hemostasis was achieved in a standard fashion. The sternum was closed with #6 wire, heavy Dexon suture, running #1, #2-0 and #4-0 silks were utilized.
Dressing and Steri-Strips were applied, and the patient was transferred to the cardiovascular intensive care unit in stable condition.
