Watch as UT Southwestern cardiothoracic surgeon Nicholas Andersen, M.D., expertly performs a complex biventricular repair, a surgery that offers eligible patients with complex congenital heart defects the opportunity to restore more natural heart function, improve circulation, and enhance long-term quality of life. In addition to his work at UTSW, Dr. Andersen is also the Director of the Complex Biventricular Repair Program and Surgical Co-Director of the Cardiovascular Intensive Care Unit at Children’s Health. The video you are about to see was filmed for educational purposes and is graphic in nature. Viewer discretion is advised.
My name is Doctor Nicholas Anderson. I'm a pediatric heart surgeon at Children's Health in Dallas. I specialize in unique surgeries called complex biventricular repair surgeries. These operations are really intended to treat some of our most complicated heart defects in children where there is uncertainty about whether we can achieve a normal two ventricle circulation or not. The patient featured here when she came in for surgery had a failing single ventricle circulation with oxygen levels in the 70s. Our goals for this procedure were to restore normal two ventricle circulatory anatomy and to also reverse the prior operations which she had undergone. Oftentimes these procedures take place in children who have had multiple prior operations and so the operation typically begins with what's called the redo sternotomy where we may have to spend some time going back through scar tissue to safely expose the heart. The patient had a complex heart defect referred to as an unbalanced canal defect with superior and inferior ventricles. It was initially felt that she was unable to achieve a normal two ventricle circulation due to the size of the ventricles, as well as the complex. Of the heart defect. And so she had previously undergone single ventricle operations. At this point at age 7, she was evaluated by our program for complex biventricular repair, and we felt that we could safely achieve a normal two ventricle circulation. Oftentimes the difficulty is quite high as a result of several prior surgeries and also the complexity of the anatomy. There are a lot of risks associated with the reoperative surgery and then also understanding very unique cardiac anatomy. In order to help us mitigate these risks and perform these procedures as safely as possible, we spent a considerable amount of time before the operation studying 3D reconstructions of the heart using advanced virtual reality 3D imaging. Once we have safely regained entry to the structures of the heart, we generally spend some time dissecting through scar tissue in order to expose all the important structures of the heart that we'll be working on. Oftentimes children have had prior surgeries related to single ventricle palliation, meaning they've had prior interventions aimed to configure their heart in a single ventricle configuration. The goal of the bi-ventricular operation is to restore the heart to a normal two ventricle circulation. The next steps generally involve connecting to the heart lung machine in order to support the circulation during the procedure. The heart lung machine pumps blood to the body and oxygenates the blood during the period of surgery when the heart is not beating, allowing us to go inside the heart safely to make the corrections that we need to make. Children who undergo complex biventricular surgeries typically have either a small right ventricle or a small left ventricle that has previously made them unable to achieve a normal circulation. There's also children who have very complex cardiac anatomy, where the techniques to create a two ventricle circulation are considered very complex. In order to perform these operations safely, it is important to have a very sophisticated and experienced team of individuals working together on these procedures. We generally have 2 fully trained pediatric heart surgeons working together on all our complex biventricular repair surgeries, and the operative team also includes highly experienced anesthesiologists, perfusionists, and nursing staff. Following surgery, a similar highly experienced team of ICU intensivists and nurses are critically important to the success of the operation. Once we gain safe entry into the heart, we will then spend time reconstructing the inside of the heart. In this patient, there was a complex arrangement between the ventricles and the valves that required complex baffling and septation of the valves to create two valves inside the heart instead of one valve. Here we are placing a stitch in order to begin the process of creating two valves out of one valve. The next step was to identify the pathways between the ventricles and the aorta and to start creating two ventricular chambers out of one that appropriately baffles the left ventricle to the aorta, which is the normal sequence of the heart. In this step, we are providing a different view of the inside of the heart to complete the complex baffling procedure. These components of the procedure are critically important to achieve a normal two ventricle circulation. Oftentimes, a number of artificial patches need to be used to create the baffle pathways and also in order to close complex holes within the heart. The patches and materials added to the heart over time grow into the heart and become incorporated into the fundamental structures of the heart. Some children will require placement of artificial heart valves. In this patient, she was born without a pulmonary valve, and so part of the procedure involved placing an artificial pulmonary valve in order to achieve the normal circulation with 4 heart valves. Here, the pulmonary valve was a donated valve from another human, and it was connected to a long graft to provide additional length on the pulmonary artery. This effectively completed the two ventricle reconstruction where we have now successfully closed the holes in the heart, created 4 heart valves, and replaced the missing pulmonary valve. This patient also had previously undergone a Glen procedure as part of the single ventricle reconstruction pathway, and so the glen connection was taken down and restored to normal anatomy. In America, there's only a small number of centers that specialize in complex biventricular repair surgery. The recovery following these procedures is very important and requires a highly specialized team of cardiologists and intensivists who understand the requirements necessary for safe recovery. The patient made a full and complete recovery and is now a very healthy seven year old with a normal circulation and normal oxygen levels.
