Week 2: The Beat Goes On

So far this week, I have observed 2 surgeries: off-pump CABG and a redo Mitral Valve Replacement (MVR).

The off-pump CABG on the 13th was the same procedure that I described in my last post. Dr. Patel exposed the heart and used a stabilizer device to limit the movement of the heart. Again, he used the LIMA to bypass the LAD and the saphenous vein graft (SVG) to bypass the obtuse marginal artery (OM). However, I did learn something new about this procedure this week. In order to bypass the OM, one end of the SVG must connect to the aorta in order for oxygenated blood to flow through. This requires making a hole in the aorta, a high pressure artery, while the heart is beating. See the problem? Dr. Patel used a device called the Aortic Cutter (pictured below) to make a precise hole in the aorta, and covered the hole with his finger immediately to stop blood from flowing out of the artery. He then inserted the seal (also, pictured below) which pulls upwards in the internal wall of the aorta. This creates an opening for the attachment of the saphenous vein without blood escaping from the hole.

Aortic Cutter

Seal

The redo MVR was an extremely complex procedure, and was hard to follow at times. The patient was experiencing severe mitral valve regurgitation, and therefore needed a new mitral valve. Since it was a redo surgery, Dr. Patel spent a considerable amount of time removing and working around scar tissue from the patient's previous surgery. During surgery, the patient was put on a heart-lung machine to protect the heart while replacing the valve. An incision was made in the right atrium and through the septum to expose the mitral valve, and it was replaced with a Pericardial Mitral Bioprosthesis (pictured below).

Pericardial Mitral Bioprosthesis