Open Heart Surgery

Posted: March 30th, 2011 under school.
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Me in my operating room attire

Me in my operating room attire

As part of my med-surg clinical this semester I had the opportunity to watch a surgery in the operating room. This OR (operating room) observation day replaces my regular clinical that week. Today was my OR day. I was thrilled when I learned that I would be observing open heart surgery–more specifically, coronary artery bypass grafting (CABG). It seemed appropriate, as I am a nursing unit secretary in the cardiology unit and we are often sending patients down for this procedure. I was excited to witness this complicated and invasive operation.

In a CABG, arteries or veins from elsewhere in the patient’s body are used to graft to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). I watched the PA (physician assistant) cut open the patient’s legs and use a scope to locate and harvest the veins that would be used for grafting. Meanwhile, the cardiothoracic surgeon made an incision in the patient’s chest, cut apart his sternum (breast bone) with a saw, and proceeded to dissect the internal mammary artery from the chest wall to use as a bypass conduit.

CABG Before and AfterI was in awe when I stood at the head of the patient and looked down at his beating heart. I teared up as I witnessed this amazing site and marveled at how advanced technology has become. My face was two feet above his chest, and I had the privilege of watching the surgeon and PA stitch one end of the vein graft to the aorta and the other end to the coronary artery just past the blocked area. The surgeon pointed out to me the area he’d bypassed in the left anterior coronary artery (LAD), and then I watched as he injected blood through the new graft to test the patency. It was amazing to see how the blood is redirected through the vein graft, detouring the blocked or narrowed artery and increasing blood flow to that region of the heart.

Due to the difficulty operating on a beating heart, this part of the operation required that the patient’s heart be stopped. This was achieved by feeding a serum containing a concentrated solution of potassium ions into the coronary artery, which feeds the heart muscle. Significantly increasing potassium in the body causes a defect in the heart’s rhythm and can lead to ceasing of the heart function. Feeding the coronary artery rapidly with a rich potassium solution causes the heart to stop within a few seconds and allows the surgeon to perform the operation on a non-functioning, motionless heart.

This necessitates the usage of cardiopulmonary bypass (CPB). The nurse explained to me that CPB (heart-lung machine) temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. Surgical InstrumentsCPB can also be used for the induction of total body hypothermia, a state in which the body can be maintained for up to 45 minutes without perfusion (blood flow). If blood flow is stopped at normal body temperature, permanent brain damage normally occurs in three to four minutes and death may follow shortly afterward. This explains why the surgical technicians occasionally threw ice onto the patient’s heart while the surgeon operated on it. They then used CBP to rewarm the patient when his heart was restarted, and the potassium was reduced to a normal level. Once the heart beats normally, the patient can be removed from the CPB machine.

I was impressed by the plethora of tools and supplies that were set out and used for this operation. To prevent the possibility of something disappearing into the patient being operated on, everything was counted repeatedly. Even every piece of gauze used was saved and accounted for until the surgery was complete. At one point the surgical tech notified the surgeon that a piece of gauze was missing; fortunately, after digging around the heart with some forceps, the surgeon located and extracted it. Crisis averted. He used a wire sternotomy suture to close up the sternum, while the PA used sutures to close up the chest and leg wounds. The surgery itself took about four hours.

The following video is a good representation of what I witnessed in the OR today. Do not watch it if you are at all squeamish (ahem, Brent).

Other nursing students with whom I’ve spoken mentioned they became somewhat dizzy, lightheaded, and nauseous from being in the OR. Thankfully I didn’t have issues with any of it. The camaraderie and synergy among the OR staff was great. The atmosphere was relaxed as we listened to Elton John, Lady Gaga, and Eric Clapton–compliments of the surgeon’s iPhone. The entire experience was amazing, and I feel very fortunate that the particular operation I was able to witness was open heart surgery. I have long been fascinated with the intricacy, synergy, and complexity of the human body; to actually see some of this presented in a living human was incredible.



5 Comments »

  1. Better you than me, that’s for sure :)
    You are a naturally caring person with a great heart – no pun intended. Patients will be fortunate to have you as a care-giver, that’s for sure.

    Comment by Dave Jacquet — March 30, 2011 @ 9:27 pm

  2. Thank you, Dave. You are very kind. :-) I certainly want my patients to feel comfortable with me and trust that I will advocate for them.

    Comment by Kirsten Uhler — March 31, 2011 @ 1:03 pm

  3. I had this proceedure done about six months ago. In my case, I had twelve, areas that were becoming blocked so they did five by-pass grafts. The atherosclerosis was very advanced and the doctors had difficulty finding veins they could use.
    My only symtum was sortness of breath. Taking a shower left me panting. I went to my doctor to be checked out to begin some type of exercise plan to build up my endurance. My EKG was completely normal, but I failed the treadmill stress test. I had an angiogram, and that revealed the problem. Three days later I was in the operating room. The procedure you discribe is exactly what was done to me.
    The first six weeks of recovery were very difficult. Several nurses and doctors commented that my recovery experience was worse than most. Now I am much better. I am stronger and feel so much better than when I first went to my doctor. I am happy to be alive. This expirence has liturally changed my life. I am eating healthier and I have lost 30 pounds.
    Every day something happens that reminds my about what was done. I have some problems with pains in my legs at the sites where viens were harvested for the by-pass. I still have pains in my chest, and other places, and of course, there is that unmistable scar on my chest. It is a good trade-off!
    It was an interesting experience I hope to never repeat.

    Comment by Dave Westwater — May 3, 2011 @ 8:34 am

  4. Wow, you have had quite an ordeal! I’m glad they caught it and that the operation was successful. I see how something like that could be a motivator to make lifestyle changes. Thank you for sharing, Dave.

    Comment by Kirsten Uhler — May 3, 2011 @ 4:21 pm

  5. i am a young 71 yr. old who had quintuple by pass six week ago…..my symptoms were merely nausea and sweating when doing heavy tasks a couple times a year so i thought nothing of it until one of those episodes was accompanied with chest pain….i failed the stress test and the blokages were found on the angiogram….recovery has been easy for me and i am virtually pain free except for the numbness etc. around the chest area….i am blessed to be alive….it helped that i never smoked, was physically fit, and not overweight before surgery.

    Comment by barbara — June 2, 2013 @ 7:12 am

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