Cole Latvis Week 6 - Observing more procedures and organizing research results

This week was again a hybrid between shadowing various procedures and lab work/reading.

On Monday, I returned to NYC from Ithaca halfway through the day. I brought with me a sample of a prototype vascular graft I had fabricated in Ithaca prior to Immersion. This elastic and hemocompatibility graft was made as part of a grant proposal our lab put together in collaboration with Dr. Weinsaft, my clinical mentor. He had only ever seen the graft over Zoom, so I thought it would be nice to bring him a sample. After showing off the conduit, I continued refining the analysis for the dataset I have been working on as part of my Immersion research.

I watched electrophysiology cases on Tuesday. I observed two and both were ablation cases to treat atrial fibrillations. I had seen these procedures in the past, but it was nice to hear about the technology used in the procedure from a new group of people. At the end of the second case, I was also able to handle both the ablation and mapping catheters after they were removed from the patient. It was interesting to finally see how the catheters were manipulated so finely by the fellows and attendings.

For Wednesday, I worked with one of the new cardiac imaging fellows all day as he worked through clinical cases. We refined my ability to read cardiac MRI and I learned more about the nuances of diagnosing ailments. When there was downtime between cases, I began putting together my research presentation. I will be the first student presenting on this Tuesday’s meeting with radiology and my peers. Demonstrating the research problem and significance will go smoothly, but I wish I had something more substantial for the results. At this point, my research data analysis is complete, and I am now waiting for an opportunity to walk through my work with Dr. Weinsaft. I hope we determine there are further directions to take this project so that I can generate more results.

On Thursday, I observed a triple cardiac bypass. For this fascinating procedure the internal mammary artery and the upper and lower left saphenous vein were harvested to serve as grafts. The veins were collected in a surprisingly noninvasive manner. A small incision was made around knee level and an endoscope-like device was inserted via bunt dissection. This tool isolated the veins and ligated the branch points. When the vessels were clean, small cuts are made with a scalpel and the veins were removed. The internal mammary artery was isolated surgically from the chest wall after the sternum was opened. For the artery, only the distal end was cut. This end was then anastomosed to a branch of the coronary arteries beyond a blockage. The vein grafts were first fixed to two other locations along the coronary arteries beyond blockages. The other ends were anastomosed to the ascending aorta, thus providing new perfusion to the diseased heart. While the artery graft is expected to last indefinitely, the vein grafts are more uncertain. Veins contain morphology and properties that differ from arteries. A degree of remodeling does occur, but vein grafts still underperform artery grafts. Currently, there are no synthetic options that approach the effectiveness of either autologous option, owning to clot formation and intimal hyperplasia leading to low long-term patency. The surgeons I talked with seemed not at all hopeful that a synthetic bypass conduit would come soon. One even told me “If you think of it, it has been tried”. This disenchantment stems from a long history of attempts to overcome the challenges of grafting small diameter arteries. I see this clear clinical need and lack of a viable current option as a great opportunity to make a device that is truly impactful, even if it is difficult. However, it does make me think the degradable vascular grafts I work on should start by targeting larger diameter vessels to prove potential before moving to the small artery realm.

On Friday, I finished organizing my research data into a presentable form, completed my slide deck for this Tuesday’s presentation, and spent the rest of the day reading vascular graft literature. During clinical MRI readings, I also watched Dr. Weinsaft teach a little about the mechanisms behind cardiac MRI.

Overall, this week felt like a very fast week. I feel that I have taken good advantage of the opportunity to watch procedures, and now I hope to make more progress on a research project in the next two weeks. Starting Monday, I will shadow Dr. Weinsaft as he meets with his patients. I look forward to this experience as well since patient interactions is one aspect of Immersion that I have not yet observed.