And Now, Some Ripped-From-the-Headlines Context.....
I'd had this video planned for the last couple of weeks. But, on Thursday, a big study came out that suggests off-pump isn't as great as everyone was hoping it would be--nor was on-pump as bad as everyone was worried about. The New York Times explains it thusly:
In the study, published Thursday in the New England Journal of Medicine, 2,203 patients were randomly assigned to have their bypass surgery on pump or off. Because the study was sponsored by the Department of Veterans Affairs, the patients were mostly men. A year later, those who had had off-pump surgery had poorer outcomes. Fewer bypasses stayed open and patients were more likely to have needed a repeat operation or to have had a heart attack or to have died. They were no less likely to have had strokes or difficulty thinking.
Older 'Pump' Heart Bypass is Best, A Study Finds, from the New York Times
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Unicorn chaser. Dear Flying Spaghetti Monster, unicorn chaser.
Shame off-pump isn't the "next big thing" as it initially appeared to be. My 6 yr old nephew will be going in for heart surgery (again) in the next 6 months, and it would be so much less stressful to the family if they did not have to stop his heart to do it. Yes, it now appears obvious on-pump is better in the long run, but the thought of a 6 yr old with no heartbeat is distressing.
Emotional reactions in these situations are not helpful. Given how anesthesia medications are suppressive of normal function, an external pump is more reliable than his own while it's being rearranged.
Consider the mechanic running the car while changing the hoses -- wasting fluids, and risking engine failure besides. Also, 'personality issues' are not a genuine medical symptom, and memory loss is the intended result of surgical anesthesia! Only stroke here is a genuine risk, and not relevant to a child patient in your case.
Take comfort that your nephew is being well cared for, and I hope he does well!
See, this is why I'm a failure as a human being; when I was a youngster, I spent my Saturday mornings watching cartoons and eating pre-sweetened breakfast cereal with sugar on it.
Maggie apparently grew up performing surgeries. How else could this be a "Saturday Morning Science Experiment"?
While this was fascinating (and not at all gross; it's not like the surgeon was sewing an eyeball or anything), I failed to comprehend the idea of the operation. I watched the video twice, going off to look up anastomosis in-between, and I've concluded that we're watching the surgeon lightly prick a hole in the heart, stick a tube in the hole temporarily, then partially attach what looks like a soggy piece of thin twine or yarn but is apparently actually an artery(!) to the new hole. A tiny hole in the side of the artery is somehow supposed to match the hole in the heart with the tube in it.
But what was the white tube for? The narrator identified it as "a 3.5mm custom-made long shunt", but what does that do for me? He sewed it in there, then pulled it out after the sewing was done. I expected blood all over the place at the extraction, or more sewing, but he just clipped of the extra twine, I mean artery, and went home (probably closed up first).
Well, I guess I should just forget my career dreams of being a heart surgeon. Just as well, I don't think I could hold my head that still for so long while doing such finicky work. My neck is sore just from thinking about it.
If you can stand to watch this sort of thing, the excellent MedlinePlus site from the National Library of Medicine has dozens of surgery videos covering pretty much everything from stem to stern, so to speak.
The shunt is to keep the blood flowing through the artery, rather than squirting all over the place like in an episode of Dexter.
A shunt is a temporary artificial blood vessel that takes the blood that normally flow through the area being operated on, so the area further on doesn't die from lack of blood. Once the new graft is in place/operation is over it's removed so blood flows through the normal blood vessel or it's permanent replacement.
I've anaesthetised for a few of these. I found them more stressful in comparison to on-pump bypass grafts - normally if surgeons do something intra-operatively that causes the heart to stop beating normally, we just them ask to stop it (please, RIGHT NOW!) and the arrhythmias (usually) get better. But with an off-pump bypass graft they're irritating the heart all the way through and have to carry on, so it became more of a negotiation over how much of an arrhythmia the patient could cope with.
I don't do any cardiac anaesthesia any more, and it may be that my experience was part of the learning curve of the team involved so others mileage may vary. But IMO the real future breakthroughs in the treatment of ischaemic heart disease will come with gene therapy/stem cell therapy and/or mechanical hearts rather than refinements of current surgical techniques. Traditional Coronary Artery Bypass Grafts can't do anything for disease in the smaller arteries and don't mend a failing heart.
reminds me of that manga: Team Medical Dragon. Asada Ryu had done the similar thing in that manga.
"Don't break my heart, my achy breakey heart"
Great, now I have that song stuck in my head.