To begin, two sections of the saphenous vein were removed endoscopically from each leg before Dr. Patel opened the chest (simply to make sure they are ready when he reaches the heart). This procedure is sometimes called phlebectomy, or ligation and stripping. A phlebectomy is also a surgical approach to treating varicose veins, enlarged veins in the legs, but in this case it is referring to the removal of the vein for CABG. Ligation is the process of tying off the greater saphenous vein, while stripping is the removal of the vein via a 1 inch incision near the groin area. Removal of a portion of this vein will not negatively effect the function of the leg or circulation. The blood that flowed through the vein will change its course (collateral circulation). The image below shows the endoscopic procedure of harvesting the vein.
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| Removing SVG endoscopically |
This surgery differed from the last mitral valve surgery that I observed and discussed earlier in that it was a repair instead of a replacement. The patient's mitral valve was not diseased or damaged so there was no need to replace it, but the leaflets were not closing completely, causing regurgitation. Thus, the valve was repaired by inserting an annuloplasty ring. This ring brings the walls of the heart around the mitral valve closer together so the valve leaflets can close completely. The image below shows the procedure of finding the right sized ring and inserting it to surround the valve.
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| Annuloplasty Ring Insertion |
The second surgery I saw this week was a quadruple bypass. I have discussed CABG procedures in previous posts, but in this surgery, a large portion of the saphenous vein was removed and divided to use for three bypasses and the LIMA was used to bypass the LAD. Also, it was an on-pump CABG, meaning the patient was on a heart-lung machine. However, when weaned off the machine, the patient's heart was beating abnormally fast (tachycardia) and was not returning to normal sinus rhythm on its own. Dr. Patel had to shock the heart to control the arrhythmia and a pacemaker was used to ensure a regular heartbeat of at least 80 beats per minute. It was exciting to see the paddles put to use! (Of course, I don't hope for every patient's heart to stop or experience irregular rhythms, because that has bad implications...it was just cool to see it in real life rather than on a tv show)
Please feel free to ask questions regarding the surgeries! It can get pretty tricky to understand sometimes. More to come next week!
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