After opening the sternum, quickly stopping the bleeding, and exposing the surgical field, Zheng Ren found that just as expected, there were heavy adhesions in the mediastinum.
The second operation is just like this. After the first operation, the human body will have fibrous connective tissue proliferation, changing the normal physiological and anatomical structure.
Looking at the sticky mess inside, Zhao Yunlong had a headache.
The elephant trunk surgery itself is the largest operation in cardiothoracic surgery, and the second-stage elephant trunk surgery...
Difficulty ×10!
Zheng Ren stretched out his hand and slapped the hemostatic forceps and blunt scissors on his hand.
Lao He took a quick look and felt that it would take at least a few minutes to open the aorta. Boss Zheng was still the surgeon. If it were anyone else, it would have taken at least 30-60 minutes just to successfully dissociate to the aortic arch.
He took out the USB flash drive, quickly found the audio file, and clicked on the song "Good Luck Comes".
Familiar and melodious music sounded, but this time Su Yun did not complain. He seemed not to have heard the background music change at all, and was concentrating on cooperating with Zheng Ren's wandering.
The two hemostatic forceps were flying up and down, which was really beautiful.
The dull scissors came free, and the snapping sound of the ultrasonic scalpel sounded.
"Prepare for heparinization." Zheng Ren said in a deep voice while freeing himself.
Lao He was a little surprised, surprised by Boss Zheng's confidence. Heparinization does not take long and is usually performed after the surgical area is prepared.
Boss Zheng was confident in his freedom, estimated the time, and asked for heparinization early in the morning.
Lao He began to prepare calmly while paying attention to the progress of the operation.
After 3′12″, the aortic arch appears completely in the surgical field.
The aortic arch and its branches were freed and cuffed separately.
"Heparinization completed."
Lao He said the moment Zheng Ren was about to put on the belt.
The time was just right, and Lao He knew that it was not because he cooperated well, but because Boss Zheng had an extremely accurate assessment of his own level.
If the medical team is a machine, it is just a component. The level of skill has long been figured out by Boss Zheng and calculated into the operation process.
The seemingly seamless cooperation is actually a reflection of Boss Zheng’s computing power. Lao He just sighed, but did not continue to think about it.
The operation was still going on at a high speed, and there was no room for him to be distracted.
After heparinization, Zheng Ren inserted the 24F arterial cannula 2 to 3cm into the right subclavian artery. Don't dare to insert too deeply on this side, because if the cannula is too deep, it can enter the innominate artery and seriously affect cerebral perfusion.
Then a secondary catheter in the right atrial cavity or superior and inferior vena cava cannulation is inserted.
"Full flow transfer to cool down."
Only one person spoke in the operating room, and the quiet atmosphere in the operating room proved the difficulty of this operation.
Oxygenated blood is supplied to the whole body from the right subclavian artery through the innominate artery to the aorta, and a retrograde perfusion tube from the coronary sinus is blindly inserted through the right atrium.
"Report nasopharyngeal temperature."
"35°C."
"33℃."
"30℃."
"27℃."
When the nasopharyngeal temperature drops to 26-28°C, the ascending aorta is blocked and cold-blood cardioplegia is perfused retrogradely through the coronary sinus.
While continuing to cool down, the disease exploration, artificial valve replacement, proximal artificial blood vessel anastomosis, and coronary artery anastomosis during coronary artery bypass grafting were completed.
Zheng Ren moved quickly, but the more he probed, the more Su Yun felt... a little panicked.
Marfan syndrome is a congenital disease. After the ascending aorta valve conduit replacement + coronary artery transplantation surgery 2 years ago, the patient's local changes were greater than originally expected.
The adhesion is very serious, let’s not talk about it for now. There is a vague bubble sign in the middle of the anastomosis, indicating the possibility of subsequent dissection.
Does surgery need to be done together with a one-stage bypass
Even Su Yun was caught off guard by this situation and had a headache.
When he saw the situation in the surgical area, he raised his eyes and glanced at Zheng Ren.
Zheng Ren didn't seem to have any emotional changes at all, and he was performing the operation calmly.
Su Yun felt a little relieved. With his boss here, what should he be afraid of
"22℃." Lao He continued to report the temperature.
"20°." Zheng Ren said.
The values the two mentioned are completely different concepts. What Lao He reported was the nasopharyngeal temperature, a key point that must be paid attention to during deep hypothermic circulatory arrest surgery.
The 20° that Zheng Ren mentioned is the angle at which the patient's head is lowered. After Zheng Ren finished speaking, the three of them stopped the operation at the same time, and Lao He began to adjust the angle of the operating table.
The side of the head is downward at an angle of 20°.
Zheng Ren then blocked the innominate artery, left common carotid artery, and left subclavian artery in sequence, reduced the arterial flow to 8 ml/kg·min, performed continuous selective cerebral perfusion, and at the same time opened the ascending aorta clamp to start aortic arch construction. Surgery on the lower and lower part of the arch.
"20℃." Lao He was still reporting the temperature attentively.
This temperature is the clarion call to start a general attack.
After Lao He reported the temperature, Zheng Ren immediately blocked the ascending aorta, and the aortic root was cold-irrigated and the heart stopped.
"Slush."
The prepared ice slushie was delivered to Zheng Ren.
Zheng Ren tried it first, with ice and water, 4 degrees Celsius. There are no large pieces of ice, only small pieces of ice, which can cool the heart as quickly as possible.
In general, for heart surgery, being able to make this kind of perfect ice slurry can at least improve the completion of the surgery by a few percentage points.
This is a detail, but an indispensable detail.
Zheng Ren was very satisfied and put ice slush on the surface of his heart to cool it down.
When the nasopharyngeal temperature dropped to 18°C, Zheng Ren began to occlude the three brachiocephalic vessels in the aortic arch. The extracorporeal circulation arterial perfusion flow was changed to 6 ml/(kg·min), and selective antegrade cerebral perfusion was performed.
The aortic arch was incised along the long axis of the aortic arch, proximally to the anastomosis of the original artificial blood vessel, and distally to the proximal end of the opening of the left subclavian vein.
Because the heart has stopped and deep hypothermic extracorporeal circulation has been established, no blood flows out when the aortic arch is opened.
The aortic arch is clean and the surgical field is clear.
The purpose of deep hypothermic circulatory arrest surgery was just for this moment, and at this point, it seemed almost perfect.
"Pay attention to the amount of blood clots in the brain." Zheng Ren said in a deep voice while incising the aortic arch: "If Lao He is not familiar with it, turn the screen 22° and let me take a closer look."
Lao He was a little ashamed. This was supposed to be the job of an anesthesiologist.
But I was in the middle of an operation, and I was still new to a new machine. I didn’t have time to get familiar with it, understand it, and get used to it.
He did as Boss Zheng said without hesitation. The ultrasound probe was placed on both sides of the patient's neck without affecting the surgical position and head. The screen was facing Boss Zheng sideways, with countless data floating on it.
The huge amount of data left Lao He at a loss what to do.
This should be a laboratory product, and it is still in its early stages. It needs computers to do precise calculations and output the results.
But now there is no final result. We can only see countless data signals appearing on the screen like snowflakes.
Zheng Ren looked up from time to time to glance at the color Doppler ultrasound screen, but the movements in his hands did not stop.