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The ultimate goal: Save a heart

Written by Emmanuella Alawode, Biology BA and MD candidate at University of Missouri-Kansas City School Of Medicine, and participant in the 2023 Institute for Public Health Summer Research Program

Emmanuella with Dr. Kaneko (left), Dr. Roberts (middle), and Dr. Damiano (right)

Open heart surgery was once uncharted territory because of the risks associated with operating on a beating heart. Extensive research developments and technological innovations have allowed open heart surgery to become an attainable feat. In the Institute for Public Health Summer Research Program – RADIANCE Track, I had the privilege of shadowing three distinguished cardiothoracic surgeons: Ralph James Damiano, Jr., MD; Harold G. Roberts, Jr., MD; and Tsuyoshi Kaneko, MD. I observed two aortic valve replacements, two septal myectomies, two mitral valve replacements, and one redo sternotomy.

Before the surgery starts, the operating room team does a time-out to confirm the patient’s identity, the procedures to be administered, a roll call of everyone in the room, and the starting time of the operation. While the time-out was happening, I was mastering the roles of the operating team. The operating team consists of the lead surgeon, cardiothoracic fellow, anesthesiologist(s), perfusionist(s), registered nurse (RN) circulator, scrub nurse, and registered nurse first assistant (RNFA).

A great deal of preparation is necessary for the operation. The anesthesia team inserts arterial and venous lines for continuous monitoring, a probe through the mouth and into the esophagus for transesophageal echocardiography (TEE), and an endotracheal tube to support breathing. The RNFA inserts a urinary catheter to drain urine. Shortly after this, a median sternotomy separates the sternum (breastbone) and exposes the heart, followed by arterial and venous cannulation to facilitate cardiopulmonary bypass with the heart-lung machine. The addition of the cardioplegia solution further amazed me, as it temporarily arrested the heart, enabling the surgical team adequate time to carry out the intricate procedures.

Following the operation, the operating team debriefs on the state of the surgery’s success, procedures completed, and to raise any concerns. Then, the team accompanies the patient to the cardiac intensive care unit (CICU) for continued care. Each member reports to the CICU team about procedures they administered to the patient in the OR and, should the surgical team be notified of any abnormalities, what to look out for during the patient’s ICU stay.

I gained many insights from my shadowing experiences. Effective communication is key. A successful surgical operation requires a multidisciplinary team approach. The surgeon takes on the role of coach, captain and referee of the procedure, providing guidance, leadership direction, and ensuring safety.

My shadowing experience was awe-inspiring. Witnessing the ability of cardiac surgery to directly intervene and address heart conditions instilled in me a profound appreciation for this specialty, and I developed a greater interest in learning more about cardiac surgical procedures. The real-time visualization of the surgical outcome through TEE was fascinating. The ultimate goal of cardiac surgery is to save hearts, one incision at a time.

I look forward to contributing to the noble mission of improving patients’ quality of life through innovative cardiac interventions. The advances in open heart surgery are a testament to the transformative power of collaboration, courage, determination and ingenuity.

The following poem encapsulates my awe-inspiring experience of shadowing cardiac surgeries.

It’s Game Day

Operating on a surgical case is much like

A game day performance.

A performance that carries the weight of a

Human life in your hands.

Scrub cap becomes your helmet

Shoe covers become your cleats

The gown becomes your jersey

Gloves and mask become your shield.

A cardiothoracic surgeon

Is one of  medicine’s greatest athletes.

Skilled and agile in the craft while Exhibiting the greatest compassion for human life.