I arrived early at Presbyterian Hospital in my hometown of Denton, Texas, around 7:00 AM this morning.
One of the catheter lab nurses dropped by to explain the procedure and answer any last questions.
My dad made a comment about seeing him and mom on the other side. He hadn't even realized what he was saying. He meant the other side, i.e. the ICU.
The OR nurse finally showed up around 8:10 AM CST.
She asked a number of questions of my mom: name, birthdate, as well as what procedure she was having.
When my dad tried to answer that last question for her, the nurse politely explained that the individual signing the consent form had to answer the question.
Just to make sure that the heart bypass patient doesn't get a leg amputated or something. I, for one, appreciated the question, which apparently has now become standard operating procedure. So to speak.
My mom answered that she was having a heart bypass operation.
Though the catheter nurse answered several of my questions, I went out to Wikipedia earlier to get a "simplified" overview of the procedure.
It goes as follows:
- The patient is brought to the operating room and move onto the operating table.
- An anesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the person unconscious.
- An endotracheal tube is inserted and secured by the anesthetist or assistant (e.g. respiratory therapist or nurse anesthetist) and mechanical ventilation is started.
- The chest is opened via a median sternotomy and the heart is examined by the surgeon.
- The bypass grafts are harvested -- frequent conduits are the internal thoracic arteries, radial arteries, and saphenous veins. When harvesting is done, the patient is given heparin to prevent the blood from clotting.
- In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
- If the case is "on-pump," the surgeon sutures cannulae into the hart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart.
- One end of each graft is sewn onto the coronary arteries beyond the blockages and the other end is attached to the aorta.
- The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases the Aorta is partially occluded by a C shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
- Protamine is given to reverse the effects of heparin.
- The sternum is wired together and the incisions are sutured closed.
- The person is moved to the intensive care unit (ICU) to recover. After awakening and stabilizing in the ICU (approximately 1 day), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days).
We don't yet know if Mom will be on- or off-pump. The catheter nurse said it really depended on the patient.
A short while ago the volunteer nurse in the "Family Care Surgery Waiting Room" informed my dad that the CPB procedure didn't actually begin until 9:35AM CST.
So now we wait.