Cardiac surgery.

On Friday I finally had the opportunity to watch open heart surgery. It was absolutely amazing.

This particular surgery was an aortic valve replacement, or AVR - it was actually a redo of the same surgery the patient had undergone about ten years ago. It's a fairly common procedure; according to the perfusion tech who was running the bypass machine, if they do 10 heart surgeries every week, 4 or 5 will be valve repairs or replacements.

The patient was brought into the OR at 8:00 AM. The nurses had already been prepping the room for over half an hour prior to the patient's arrival. Things moved quickly once the surgeon (a FEMALE! Woo!) arrived; the nurses and the surgeon scrubbed in, and the patient was draped while the anesthesiologist put the patient fully to sleep and checked all the lines and equipment, and then the surgery began.

Dr. R (the surgeon) made a long incision down the patient's chest using a scalpel and bovie. The breastbone was soon exposed and Dr. R removed the six metal wires holding the bone together from the patient's previous AVR. There was quite a lot of scar tissue, so before the breastbone could be sawed through, Dr. R used her hands to reach under the bone from the top and bottom to make sure that the heart and pericardium hadn't become attached to the bone. She then used a jigsaw to slice through the breastbone, fitted a retractor on either side, and opened the thoracic cavity.

I only caught a glance at the opening for a few seconds, but from where I was standing near the patient's head, the heart could clearly be seen pulsating under the pericardium, and the lower lobes of the lungs could be seen expanding and contracting through the scar tissue on either side of the heart. It was pretty cool.

The next two hours were spent putting the patient on the cardiopulmonary bypass machine. I won't go into the details of how that was done, but if you're interested, here is the Wikipedia article describing the process.

With the patient on bypass and the heart and lungs stopped, Dr. R moved on to the actual procedure. With the help of another surgeon, she removed the old aortic valve and fitted the patient for a new one using a special set of measuring devices. She then used 16 sets of sutures to sew the replacement valve into the aorta and sewed the aorta closed. At this point the patient was taken off of bypass and the perfusion tech began to rewarm the body by warming the returning oxygenated blood. After checking the valve placement with a transesophogeal echocardiogram (TEE), the clamp on the aorta was removed. Ten minutes later the bypass pump was turned off and the patient's heart and lungs began working on their own again.

The rest of the surgery involved removing the cannulas from the heart, checking the new valve again with the TEE, and closing the surgical site with a combination of metal wires, subcutaneous sutures, and superficial sutures. The entire surgery lasted about 4.5 hours; the patient was on bypass for 2 hours and of that time, the aorta was clamped for 98 minutes. I learned that this was important because the longer the aorta is clamped, the higher the risk for spinal cord ischemia and paralysis.

After the surgical site was closed and all the instruments accounted for (107 needles alone needed to be counted!), the patient was transported to the surgical ICU, where he would recover and be monitored for a few days. I left the OR in a strange state of excited calmness, mind racing but feeling oddly relaxed and peaceful regarding what I had just witnessed. Thinking about it now, I was probably just tired from standing in one position for so long.

All in all, it was a fantastic experience, and I consider myself very lucky to have been able to watch such an intense procedure up close.