Sunday, August 14, 2005

Monster Garage

Image taken from Thoratec Corporation website without permission. Image property of Thoratec Corporation

I've been a full time cardiac anesthesia staff now for about a month. I thought I would be spending more time in the heart room, but it only ends up being about one day a week. Oh well. i don't mind the general ORs.

Wednesday was an interesting day in the OR. Two big cases by the newest cardiac surgical staff -- he just started in July, the same time as I did. They're giving him pretty big cases even though he's the most junior. Maybe it's a way of breaking him in or something. I don't know.

Our first case was an exchange of an abiomed LVAD for a heartmate LVAD. LVAD stands for left ventricular assist device. It's type of support to help the heart when it can't function well enough on its own. The difference between the two devices is that the first is a mini-fridge size device that sits next to the bed and has tubes connecting it to the heart... the second is an implantable device (think softball sized tuna can) connected to the heart to help pump. Patients with this devices can even go home. Mostly it's used as a bridge to transplantation. It wasn't a terribly long case, but it can be complicated. There's multiple vasoactive medications, nitric oxide, and a transesophageal echocardiogram to deal with. Also a tangle of IVs and lines. Went very well though.

The second patient had an even sicker heart. He had a Heartmate LVAD(see above) supporting his left heart and a abiomed RVAD (right ventricular assist device) supporting his right heart. He had recovered enough function in his right heart to have the RVAD removed. There's no cardiopulmonary bypass, but you have to deal with the possibility of a lot of bleeding. ALso the possibility exists that the right heart isn't ready to come off support yet and will fail after you cut off support. Again it went pretty well so I can't complain. But there's a lot to think about and take care of. I guess that's why I like being in the cardiac ORs

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