Watch as Karl Reyes, M.D., performs a re-sternotomy for a pulmonary valve replacement and main pulmonary artery augmentation on a patient who was born with a congenital heart defect.
We are here today at Children's Medical Center in Dallas Ut Southwester to do a pulmonary valve replacement. This is a patient who was born with a congenital heart defect that had a repair when she was younger and now she needs a second repair or a second surgery because she has had long standing pulmonary valve regurgitation and her heart has started to enlarge and because of that, it was deemed time to place a pulmonary valve. What we are doing is getting ready to open the breast bone or the sternum. We have these special retractors that's called a re annoy retractor and as you can see, it lifts the sternum up safely. Yeah, the heart is beating underneath, but you're able to basically divide the sternum without injuring the heart. There are two surgical assistants or they're basically helping me with the operation, helping me retract and expose areas that need to be exposed. One of them is usually a trainee eventually he or she will be doing this operation as well. So this is opportunities for them to see these operations and learn how to do them. You have your surgical techs who will help you with the instruments that you need. We have our advanced practice providers, our nursing staff as well. Our cardiac anesthesiologists, we have our perfusionist who run the heart lung machine. Now, the sternal retractor is in and we're able to separate all the structures. As you can see, when you've had surgery. In the past, all the structures around the heart are fused together and you have to separate all those structures that are fused together, disappear. This procedure typically will take anywhere from 3 to 4 hours from the time you make your incision to the time that you close. Even the simplest of the congenital heart surgeries requires a lot of thoughtfulness and how to carry on the operation so that you can continuously be successful. That is the aorta, I am dissecting between the superior vena cava and the aorta. And that's just part of preparation. What's unique about pulmonary valve replacement at UT Southwester is that we are able to do this multiple ways. This one way is to do a surgery, but we also have other ways to replace pulmonary valves using the Cath Lab. If there is an adequate enough ring around the pulmonary valve annuls, then they can go to the Cath lab and deploy a valve. The next step after shaping out the heart is to put the patient on the heart lung machine to do that. We place these cannulas, they're basically tubes that will pull blood out of the body and go to the heart lung machine and then put back into the body. That's the one canyon that we're putting in that goes into the AORTA, that's it. That's the canyon that goes into the right atrium that drains blood out of the body and goes to the heart lung machine. Being one of the only adult congenital heart programs in this region means that we get the whole spectrum of adult congenital heart disease. And we also have the highest volume in this region. Currently, we are preparing the patient for the pulmonary valve replacement. The patient is already on the bypass machine or the heart lung machine. And we are separating the pulmonary artery from the aorta. Once we've separated the main pulmonary artery from the aorta, we will be opening the main pulmonary artery for this particular patient. We had to stop the heart to do the operation. We are now stopping the heart, we're giving the solution that is a concentration of potassium, calcium and magnesium that makes the heart a rest. Now, the heart, as you can see is fully rested and relaxed. We have opened the main pulmonary artery and now we're exposing the pulmonary valve. That area below is where the pulmonary valve will sit. And we are currently sizing that using one of these valve sizers 391. Once we've determined the correct size, we will sew that valve into the main pulmonary artery. We're currently sewing a bovine valve into the pulmonary valve annulus. When I perform open heart surgery, you almost have to be in a mentally quiet zone where you're thinking of what, you know, as a surgeon and the procedure that you're doing, knowing your task for the hour. And you know that it's composed of multiple steps and you have to break everything down into the steps that you need to do. What we're going to do is sew this pulmonary valve to the back wall of the pulmonary valve annulus. And for the front wall, we're going to use a patch which is made out of bovine pericardium to enlarge the anterior portion of the pulmonary valve. What you see there is me cutting the patch and we will be sewing that patch to augment the anterior portion of the main pulmonary artery. Ok. Ok. Now, we are just checking inside, making sure that everything is wide open. So I'm completing my anastomosis or my suturing of the patch. Once we're done, we will remove the clamp and almost miraculously the heart will restart that halfway that the heart as you can see is starting to beat again. Thank you. They 100 for the c majority of patients who have pulmonary valve replacements will be in the hospital from 3 to 4 days after surgery when the lights turn green. Typically, that's when we're calling for our cardiology colleagues to do the echocardiogram. What they're doing is they're looking at the result of the repair. So they're going to be looking at the heart using an echo that goes through the esophagus. If the valve is moving, well, they look, it's basically our determination of a success of the repair. We're putting wires in to close the chest. These are stainless steel wires that's basically just to hold the sternum or the breast bone together. Typically, it takes about 6 to 8 weeks for a sternal bone to fully heal. And so these wires will keep it together until the bone is fused back together. The adult congenital heart program at UT Southwester has been very successful over the years, the complication or morbidity rate of even the most complex procedures at UT Southwester is very low. This institution has been doing adult congeal heart surgery for decades and even if you say it's already a very good program, it has all the elements to become the best program in the country.
