Perioperative Care for Patients Undergoing Right Mini-Thoracotomy Sutureless Aortic Valve Replacement: A Case-Based Approach

Abstract

    Right mini-thoracotomy sutureless aortic valve replacement (RMT-SLAVR) is a novel cardiac surgical technique that combines the advantages of minimally invasive surgery and sutureless valve implantation. This approach enhances surgical efficiency, reduces cardiopulmonary bypass (CPB) time and aortic cross-clamp time, and lowers the risk of complications, particularly in older or high-risk patients for conventional open-heart surgery. This article aims to present perioperative nursing care plans based on a case study of a 64-year-old Thai female diagnosed with aortic valve stenosis and regurgitation who underwent RMT-SLAVR. Nursing care was structured using the Perioperative Nursing Data Set (PNDS) developed by the Association of Perioperative Registered Nurses (AORN), which consists of nursing diagnoses, interventions,and expected outcomes. The care plan emphasized a holistic approach, identifying five primary nursing diagnoses: 1) Knowledge deficit related to the surgical procedure; 2) Anxiety about the surgery and outcomes; 3) Risk of retained surgical items; 4) Risk of injury from operating room instruments and environment; and 5) Risk of impaired cardiac, cerebral, or vascular tissue integrity due to CPB.

Nurses play a crucial role in assessing both physical and psychosocial risk factors,especially in older patients with comorbidities such as diabetes, hypertension, or cognitive impairment. Preoperative preparation includes providing visual materials, encouraging patient questions, and involving family members to reduce anxiety. Intraoperatively, nurses required specialized skills to prepare and handle devices such as video-assisted equipment and extended retractors, as well as to ensure accurate instrument counts to prevent the retention of items. Nursing care also included proper patient positioning, temperature regulation, emergency readiness (e.g.,defibrillator setup),  and collaboration with the multidisciplinary team, including surgeons,anesthesiologists, and perfusion technologists. Postoperatively, nurses were responsible for assessing vital signs, circulation, and level of consciousness prior to transferring patients from the operating room.

This case study highlights the need for specialized knowledge and skills in perioperative nursing care for RMT-SLAVR patients, as well as systematic interdisciplinary collaboration. The PNDS framework supports comprehensive planning to address both physical and psychological aspects of care, aiming for optimal safety, comfort, and outcomes. Future applications of this nursing approach could extend to other minimally invasive cardiac surgeries, such as mitral valve repair, minimally invasive coronary artery bypass, or hybrid procedures. The dissemination of such case-based knowledge is valuable for both clinical practice and professional development in cardiac surgical nursing.

Keywords : Aortic valve, Case study, Minimally invasive surgery, Perioperative nursing,Perioperative Nursing Data Set (PNDS), Sutureless