So, today i had a little treat–i got to watch coronary artery bypass surgery. It was VERY cool. I’m sure most of you have heard of “open heart surgery,” or “triple bypass.” In the medical world it is sometimes referred to as CABG (pronounced “cabbage”), which stands for coronary artery bypass graft surgery.

 

When people call this “open heart surgery”, they are not far off the mark. It’s very… open. Basically, a long incision is made down the chest and a saw is used to cut through the sternum. Throughout the whole surgery i was having flashbacks of the Saw Trilogy. (I hate scary movies, and these aren’t movies i would normally see, but i was semi-recently forced to watch the whole triology in 1 night–those are images you can’t get out of your head, and today some of the contraptions the surgeons used really reminded me of that movie!). I am not trying to compare the surgery i saw today with the guys in Saw….Proper surgical technique and precautions were employed throughout the whole surgery: bleeding is controlled as much as possibly with the aid of diathermy/cauterization, and everything is monitored by the anesthesiologists present. Anyway, i digress. Before the surgery began, the registrar began harvesting the vessels from the patient, which would later be used to “bypass” the “bad” vessels in the heart. In this particular patient today 2 vessels were used: the great saphenous vein (a vein in the leg, click here for Wikipedia anatomy picture) and the internal mammary artery (AKA internal thoracic artery) from the chest wall. The patient was connected to a perfusing pump throughout the surgery so that his blood could continue to perfuse the body. This is called cardiopulmonary bypass and it was very cool to watch them hook all the tubes up. It was also amazing to watch the surgeon hold the patient’s heart in his hands. (Incidentally, the bypass machine was a lot larger than i thought it would be. Pic taken from http://www.firstheartnorth.com/index.php?page=procedures). The heart was then stopped (a process called cardioplegia) by decreasing the temperature and introducing a potassium solution.

 

While the heart was stopped, the surgeons could go about grafting the harvested vessels to the occluded coronary arteries. Prior to the surgery, the surgeon reviewed the patient’s angiogram with us on his laptop. The angiogram was used to visualize which arteries were stenosed. Then, the surgeons anastomose (or join) the harvested vessel to the occluded heart artery and the other end was jointed to the aorta. This process took a very long time since 4 different areas needed to by bypassed. Once all the anastomeses were created, the heart was slowly warmed and restarted. The patient was taken off the bypass machine, and the sternum was closed with wire loops. The whole process took just under 4 hours.

 

Another exciting thing that happened was that another patient who had undergone the same surgery the day before had to have his chest reopened for exploration (to determine the cause of ongoing bleeding from the surgical site). Because we had 1 patient all ready to go in the operating suite, we had to all go down to the ICU where the patient from yesterday was recovering. He was just lying in bed with his chest completely open (covered by sterile bandages of course). He was also still connected to a bypass machine (although a much smaller, different one than used in the surgery, called ECMO). It was all very dramatic, the surgeons scrubbing in on the ICU, the ICU patients all looking around to see what all the comotion was about. The surgeons determined that the bleeding had settled down on its own, although they left the sternum open to have the wound monitored in ICU for a few more hours.

 

This was a pretty amazing experience. I’m glad i had it for 2 reasons.
1) The obvious educational experience
2) This is the stuff i used to love about my old job (although i was perfusing rats for research, not humans therapeutically). Before medical school, i thought for sure that i wanted to be a cardiothoracic surgeon. Even though the surgery was amazing to watch, and the free lunch provided (every day) by the private hospital were pretty cool, I’m almost positive that I couldn’t be a surgeon. I was starving by about the 2nd hour in, and i was very happy to not be scrubbed in so i could scratch away at my face, hand, arm, etc at will. Hm…. I have plastic surgery next, so i still have time to decide, but i’m pretty sure that i’m leaning towards medicine.

 

—-
On an unrelated note, i kept my cell phone but 3D returned his and bought a new case for the old one. He just couldn’t bring himself to keep the new one. oh well, can’t teach an old dog new tricks! :)