Week 2

This week I saw my couple of open heart surgeries: the implantation of a left ventricular assist device (LVAD), another valve replacement, and a coronary artery bypass graft (CABG); each of which typically commits me to an entire day in the OR. I was surprised to learn that the surgeon doesn’t come until the patient is asleep and its rip/heart cage completely open, which in many instances takes about two hours of preparation. Similarly, the surgeon leave way before the patient is completely sutured. Only the core work (1/3 of the entire procedure) is done by the surgeon while the rest is performed by the fellows and physician assistants. During each surgery, the surgeon walks through each step of the procedure with his fellows, like a lecture given by a wise scholar its disciples. There is an interesting sense of hierarchy and respect present in the OR. For instance, as soon as the surgeon enters the room, you feel the presence of the chief and everyone must unconditionally follow his orders. I must admit that for all of these surgeries, observing the rip cage being sawed open with pieces of flesh occasionally flying across the operating table is a bit discomforting. Likewise, I am also not particularly fan of the electrocautery blade they use to cut through flesh and prevent blood from leaking (hemostasis) as well as the smell of smoked burnt flesh it generates. Surprisingly, I am not sensitive to blood nor open bodies.

The LVAD procedure was particularly interesting. LVADs are placed in patients with an advance stage of heart failure either as a definitive solution or for patients waiting for a heart transplant. It is a rather large device  that is placed inside the rip cage and which connects the left ventricle to the aorta. Once implanted, you cannot remove the device. It assists a fatigued heart in properly pumping blood through the system. The device also has a percutaneous tube to an external controller and batteries through the patient’s belly. The battery pack is huge and patients need to carry them all the time in a dedicated backpack.

I also met with my mentor to discuss about my project. To start, I am going to assist him in analyzing data for a clinical study. It will be a good excuse for me to learn how clinical research is done. He is interested in comparing difference patient and operative characteristics between two high-risk patient groups that have undergone a transcatheter aortic valve implantation (TAVI). More next week!