Cape Town - A front-row view of cardiopulmonary bypass surgery was the last thing a junior reporter, like me, ever dreamt of finding on her morning news diary.
But when the Cape Argus received the call to join surgeons operating at the Christiaan Barnard Memorial Hospital early this week, I swallowed my squeamish tendencies, and donned my scrubs.
The surgery was for a 54-year-old man who was suffering from cardiomyopathy. He was admitted three weeks ago after having suffered a heart attack three years ago.
According to Dr Willie Koen, head of the hospital’s transplant programme, the patient’s health was deteriorating.
“His kidneys and liver were starting to shut down.”
Koen said the HeartWare Ventricular Assist System (HVAD), commonly known as the “heart pump”, would give the patient about six more years.
This type of surgery is rare and has only been performed six times since its launch in 2012. It is only performed at Christiaan Barnard Memorial Hospital.
Annually the hospital received 10 to 15 donor hearts, but there were more than 5 000 patients waiting for a new heart. Koen said many patients died before receiving a donor heart.
The heart pump is implanted inside the heart. It has an electric cable that runs through to the stomach, where it is attached to batteries that need to be charged every six hours.
Entering the theatre dressed in scrubs handed to me by one of the nurses, the nerves kicked in. I am about to see a real live beating human heart.
The cold theatre room is cluttered with equipment, from heart-lung machines and ultra-sound machines to tables with instruments and a bed with an unconscious man waiting to be operated on.
“It’s a four-hour surgery,” Koen warns.
The surgery starts at about 8am with two doctors and nurses on either side of the patient, an anaesthetist, two perfusion technologists, and me.
Feeling a bit out of place, I take a peep at the patient’s face. He looks healthy but in a deep sleep. There are black dotted lines on his chest, while the rest of his body is covered with green and blue hospital sheets. Pipes seem to poke out of every body orifice.
The first task is to cut his chest open. Doctors use scalpels, forceps and a gun-like bone cutter.
Nurses are on standby with swabs and other instruments such as bulldog clips, needles and the heart pump.
Once the chest is cranked open, the next step is opening the heart sac.
This particular patient has an enlarged heart which did not contract fully, so the heart pump is going to do 90 percent of the contraction for an easier blood flow.
As soon as the heart sac is opened, perfusion technologists quickly plugs in the heart-lung machine.
“This machine will do the work of the heart. It will transport the patient’s blood from the body, perfuse it with oxygen to it and then pump it back in again,” says Koen.
Doctors make a small hole in the left side of the heart where their device will be implanted.
Meanwhile the anaesthetist constantly checks his equipment to make sure the patient is coping.
A camera tube is pushed down into the patient’s stomach, pulling an electric cable.
Once the device is securely implanted and the cables in place, the perfusion technologists and doctors check the heart for pressure and blood flow.
Koen says he is happy with the results on the monitor screen and the doctors begin stitching the patient up.
“See there,” Koen says, pointing to a urine bag below the bed, “the patient has been urinating a lot, meaning his kidneys are getting the blood and are working perfectly,” says Koen.
The patient is wheeled out of the theatre and I let out a deep breath. It feels as if I have been holding my breath for hours.
After the surgery the patient was wheeled to Intensive Care Unit where he would remain for a week before being moved to a normal ward.
Koen said after six weeks of physiotherapy the patient could return to his normal day-to-day work.
Cape Argus