Inside St. Luke’s OR: Open Heart Surgery

UnityPoint Health – Cedar Rapids Heart
and Vascular Institute takes you inside the heart for an aortic valve
replacement surgery at UnityPoint Health hospital in Cedar Rapids, Iowa
our patient is Cory Ranney. He’s a 50 year old Marion man with a bicuspid
aortic valve condition he was born with and it was identified 25 years ago by his UnityPoint Clinic family doctor. This congenital heart condition led to aortic stenosis. it’s an aortic valve and it tends to leak. It would leak when it pumped so it would
have to pump extra when it would pump which is hard on your heart so it needed
to be replaced so it don’t leak. Aortic stenosis is the tightening of the
aortic valve. The aortic valve typically opens and closes each time the heart
beats and in people over time the valve can become calcified. So each time the heart would beat the valve doesn’t want to open properly
it puts a lot of extra work on the heart to pump blood out each time the heart
goes to beat through a small In his situation he was born with what’s
called a bicuspid valve meaning that congenitally it was slightly malformed
compared to what a normal valve is and that resulted in earlier onset of aortic
stenosis. For him today we’re gonna replace his valve and put in a
mechanical aortic valve to take the pressure of his heart. Dr. Gary Weide, a cardiothoracic surgeon from Physicians’ Clinic of Iowa will be performing
today’s aortic valve replacement surgery on Ranney. Joining Dr. Weide in the
operating room is an anesthesiologist, a perfusionist who operates the heart-lung
machine, a physician assistant and St. Luke’s highly skilled open-heart team of
nurses and surgical techs. Because of Ranney’s young age the decision was made to replace his aortic valve with a mechanical valve rather than using a
tissue valve that has basically a life long durability to hopefully last the
rest of his life. Other valves one can choose from would be called a tissue
valve. The valve is typically produced from the heart sac of a cow, the downside to
that valve is it has a life expectancy of about 10 to 15 years so when a guy
who’s young and 50 years of age. You don’t want to go in the direction that would
result in another operation at some point of his life. He’s opted to have
a mechanical valve hopefully for a lifelong solution to this problem. This is true open heart surgery. We open the chest we go on the heart-lung
machine. We stop the heart for a period of time, and take out the valve put in a
new valve and then start the heart once again. Another option for aortic valve replacement and treating aortic valve
stenosis is through non-surgical treatment called TAVR which stands for
transcatheter aortic valve replacement. St. Luke’s started its TAVR program in
2016. Dr. Weide explains how they decide
which procedure is best for patients. These procedures are relatively common, it’s probably the most common valve procedure that we do. I would say
over the last four or five years things have changed dramatically in how we
treat aortic stenosis with the introduction of TAVR. It has really kind of turned the number of patients that were once open
procedures to more catheter based valves. The TAVR valve is a tissue valve so in Corey’s situation I
think he did have an option for a TAVR valve but again it would have been
a limited durability as far as the valve goes so we opted for open heart surgery forthe mechanical valve to hopefully never have to deal with this again.
Ranney’s open-heart surgery is expected to last about three hours. Dr/ Weide makes an incision in the middle of the chest and then cuts
through the sternum, cannulas are then inserted so the cannulas are basically
tubes that we use to drain the blood out of the heart to circulate through the bypass
machine and then it goes back into a separate tube into the aorta. That basically pumps blood throughout the patient’s entire body while the
heart stops so it continues to provide whether the brain and the kidneys and
the liver and everywhere else so we can stop the heart and then work on the
heart while it’s not it’s more so the cannula is essential to
bypass surgery that’s essential to the operation we usually basically goes on
bypass and then we we put a clamp generally on the the aorta and then we
deliver was called cardioplegia which is a high potassium solution that’s used to
stop the heart and then every 15 or 20 minutes we have to keep giving that
solution to keep the heart stopped. It also protects the heart from injury
during that time as well. Dr. Weide removes Ranney’s a aortic valve. This valve like we talked about was
a bicuspid valve. It was calcified in the sense that it didn’t want to open
particularly well but in addition to not wanting to open well, the stiffness of the
valve makes it not want to close as well. either so the valve not only was just a
naughty but it relieved and replaces it with a mechanical a or dick valve they come in various sizes for various
size people of course I mean the goal is to generally try to put the biggest
valve to put in but at the same time he’s you got to be able to accommodate
it into the Hartmann to the aorta so here at the mercy of that so in him you
we measured three different sizes and we came up with a you know 25 Valve’s
actually a pretty good sized valve for him everybody is unique in the sense of
size and goes and then like I said we we pass multiple sutures around the annulus
like we talked about and they’re like I said they’re color-coordinated and
they’re kind of individually laid out and it’s important to keep track of all
those they don’t get all tangled together and then we pass them through
the valve sewing ring itself and then slide the valve down over the sutures
and then tile the sutures and that’s what it secures the valve into the heart
now so it doesn’t pop out or move out testing just make sure the valve
leaflets open it close it means make sure that there’s nothing under the
valve that’s impinging the valve leaflets because they pivot back and
forth so want to make sure that they pivot fully they open to their maximum
extent and they close they come together so the valve doesn’t leak in general
it’s that’s the only not a problem most of the time when you clean everything
out the valve leaflets will pivot open and close like problems but it’s always
good to double check before you close there’s a lot of ways to close the chest
I mean the most common way is with you know six or seven you know a surgical
stainless steel wires and it works well for the more
people and that’s what we did for him and and I think you’ll do with it just
does that thing in the wires will say I think everything went well I think
everything went when asked plan and then no surprises nothing comes I think the
valve the appearance of the valve is what we expected it functioned the way
that we thought it was functioning me we got it out or nicely we clean everything
up and actually got a pretty sizable loan and there so I would say overall
this quite a success in mechanical valve and to take you our he’ll have to be in
a blood thinner you have to be on a blood thinner for the remainder of your
life which requires you to get some blood drawn you be on coumadin or
warfarin so you get your blood checked regularly that’s the that’s the one
advantage to a tissue valve is you don’t need to be on that but it has limited
durability so you kind of trade the durability for the anticoagulation and
Cory as it gets it’s probably the best best decision for him but you know long
term you know he’ll go through cardiac rehab after he gets out of the hospital
for you know two to three months and then hold on periodically have an echo
to make sure the valve is still functioning fine and make sure that it’s
doing okay but a mechanical valve in particular this should it should really
last down years about the rest of his life after
his surgery rainy spent a day in st. Luke’s intensive care unit and four days
total at st. Luke’s I’m doing a lot better than I anticipated
I very thankful for the for the help that was it was here I see you from that
to my departure was was wonderful surgery I don’t know anything about I
went in there they put a mask on me and I was done
you gonna wake up and I see you so I don’t remember anything there but from
ICU to the time of departure was wonderful it’s been a little over three
weeks since his open-heart surgery and Rainey is participating in st. Luke’s
cardiac rehab I prepared myself for a lot worse than I have actually
encountered I wouldn’t I wouldn’t anticipate where I’m at now that’s just
over three weeks post-surgery and feel great I figured that I would feel a lot
worse I planned a big feel a lot worse Rainey
will continue attending cardiac rehab and follow up with his doctor he hopes
to put his surgery behind him soon as his body continues to heal and he looks
to return to work in the coming weeks class act
everything went great as anticipated the post care has been great today I had
rehab and that was great so from from the start to the finish I
had very good care unity point health st. Luke’s Hospital is Cedar Rapids
Heart Hospital it has been the area’s leader in open heart surgery since 1978
we invite you to learn more about our program and st. Luke’s heart care
services today

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