Different Surgical Atmosphere

The directed studies course that I took the past semester with Dr. Wasser was one of the most interesting and rewarding courses that I have taken at A&M, and the opportunity at Bad Oeynhausen provided a unique twist to the surgical observations that I expirienced at St. Joseph's. At the Heart and Diabetes Center in Bad Oeynhausen I had the opportunity observe aortic valve replacement in an elderly patient. Which I found to be very similar to the CAB procedures that I had observed at St. Joseph’s. Of course, this procedure didn’t require the surgeons to harvest a vein from the patient’s leg or to dislodge the internal mammary artery from the chest wall, but they did follow identical procedures to place the patient on bypass and to access and stop the heart in the abdominal cavity.

After the first two surgeons had stopped the heart, another surgeon entered the room to begin working on the heart and the aortic valve. For this patient, they were using an organic valve replacement or, more specifically, a porcine valve replacement (Medtronik). I thought that this was an interesting choice over the variety of valve replacements which could have been chosen, and I later found out that a variety of factors, such as age, influenced the decision for this patient.

The surgeon first made an incision around the aortic valve in the aorta and removed the patients defective aortic valve. The surgeon then used a device to measure the size of the aortic valve, and he chose an appropriate size of porcine material to place in the patient. The surgeon then sowed the porcine valve into place and closed the aorta.

Again, at this point the procedures to take the patient off bypass and restart the heart were identical to the CAB procedure which I had already observed at St. Joseph’s. However, in my previous surgical observation they did have to defibrilate the patient to restart the heart. In this case, the patient’s heart was in fibrilation, and they used the small defibrilation paddles to bring the heart back into rythm (which is relatively common).

I was intrigued by the similarities and the difference between my surgical observations here and at St. Joseph’s. I expected the procedures to be relatively the same, but the increase in sterilization precautions taken at Bad Oeynhausen caught me off guard. The increased security measures of the hospital and decreased excessiblity to the surgical ward at Bad Oeynhausen also created a very different observational atmosphere than what I had expirienced at St. Joseph’s. I also felt more secluded and was reluctant to ask the surgeons any questions. However, these feelings could have been exacerbated by my inablitity to communicate effectively with other people in Germany because I did want them to have to go through the chore of translating their thoughts into English, even though their English skills were excellent, and distract them from their task at hand.