Week 4 - Chase Webb

Even though it was short because of the 4^th of July, this week was very exciting as I got to see my first surgeries. After attending rounds in the Cardiac ICU at 6:50am, I changed into scrubs, put on a hair cover, face mask, and protective glasses and went with the cardiothorasic surgeons in to the operating room. I got to see two procedures, an aortic valve replacement and a double CABG (coronary artery bypass graph). For the aortic valve replacement, the surgeons opened the atrium to access the aortic valve, trimmed away the deteriorated leaflets, and sewed in the new valve. The most interesting thing about that procedure for me was the use of little plastic circles on sticks the surgeons used to gauge the size of the prosthetic valve they would need. These guides allowed them to pick the specific diameter of valve that would fit best in that patient, which a nurse was then sent off to retrieve. I liked that this was a simple but effective way of estimating the valve needed without putting whole valves of different sizes in to see what worked best. For the bypass, I got to see both a radial artery graft (similar to a saphenous vein graft but using the radial artery from the arm) and left internal mammary artery (LIMA) graft. This was a great procedure for someone to see who had read and heard about both forms of bypass but had not seen either. The radial artery graft involved the removal of the radial artery from the arm and stitching it both above and below the site of blockage to restore blood flow to the blocked artery in the heart. The LIMA graft involved only removing the LIMA from the muscle it supplied and attaching it below the blockage in the heart to reperfuse the area, leaving it attached to its original source of blood. What I found interesting about this procedure was how much control the surgeon has over the procedure, things like shaping the edge of the vessel with a scalpel to best fit it to the heart and where to attach it to the coronary vasculature both to allow for secure attachment and good blood flow. Being able to stand next to the anesthesiologists at the head of the patient, arm’s length from the heart, gave me the best view I could have wanted to see this in action.