Introduction to NYP Cardiothoracic(CT) Unit and first time in OR!

It's my first time in the OR, and I love it😍! Summer Immersion was one program I looked forward to when I joined the BME program at Cornell. I was super excited about the experiences and opportunities it presented, and I looked forward to enjoying every bit of it.  

Aminat and Dr Tranbaugh preparing to go into the OR

My week started with meeting my clinical mentor - Dr. Robert F Tranbaugh at New York-Presbyterian (NYP) Methodist Hospital. He introduced me to the Cardiothoracic team, who were eager to have me join and work with them. I was prepped about the case at hand and boom! off to have my first OR experience. I observed two major surgical procedures this week – Coronary artery bypass grafting and Pericardial window.


To give a background, Coronary artery bypass grafting (CABG) is a procedure used to revascularize diseased cardiovascular tissue. This procedure is very important because a lack of blood flow to the heart could result in an ischemic heart attack (dead heart tissues, which can cause death). The patient was administered anticoagulation therapy before surgery, and the procedure was conducted under full anesthesia. Two radial and two intra-thoracic arteries were harvested to replace the occluded arteries of the patient. One conduit was anastomosed to the Left anterior descending(LAD), one to the circumflex, one to the left diagonal, and one to the posterior descending artery (PDA). Before the operation, the patient was placed on a CPB machine (a revolutionary device in the field of heart surgery that takes on heart function during cardiac surgeries), and a cardioplegic therapy was administered to stop and cool the heart - to prevent any ischemic effect.


One major challenge observed was that the conduit anastomosed to the circumflex was very soft, which led to tearing of the conduit and resulted in a shortened length. This was resolved by connecting it to an adjacent previously connected LAD, which led to the surgery taking longer.


In addition, I observed a Pericardial Window Procedure, where excess fluid was drained out of the patient's pericardial sac. This procedure is necessary for patients with pericardial effusion, as lack of treatment could lead to the buildup of intrapericardial pressure which prevents the heart from ejecting blood effectively (cardiac tamponade), thus, impeding cardiac function.  

  

These procedures provoked my thoughts on:   


  1. - Can we develop more biomimetic grafts to: reduce the time and effort surgeons use in performing this procedure; help reduce the risk to patients; produce grafts in abundance?.  

  2. - Are there revolutions that BMEs can provide as alternatives to performing this procedure without using anticoagulant and its neutralizer like designing tubes 'that do not clot'?  

  3. - Why thrombosis or clotting remains a huge challenge in the clinic, especially in relation to heart surgeries.   

  

Finally, I went on a ward round with the Doctors to do some follow-up or Post Ops, i.e. check on patients that got the procedures done and monitor their recovery phase.  


Overall, I have been able to improve my understanding of some cardiac diseases, procedures carried out to prepare patients for surgery, and identified some technological challenges clinicians face. Also, I see a huge need as to why my research on "reducing thrombosis on implantable cardiovascular implant" is very important and can help make a meaningful impact in the cardiovascular space. I look forward to starting my research project and observing more surgeries next week.  



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