Day #9: Thursday, November 1st: 'A Really Really Long Pump Run'

Case #10:  Aortic Root Replacement with Composit Graft and Saphenous Vein Graft x 2

This year I was able to bring a Vanderbilt University perfusion student with me on the trip.  Johnson is a senior perfusion student and will be graduating from our program in May 2013.  He has performed over 150 open heart perfusion procedures so far in the program at various rotational sites in Nashville.  He was due to start his pediatric perfusion rotation with my staff and I at Vanderbilt Children's Hospital the day we left for Kenya.

Although our primary objective was to work with the Kenyan medical staff to train them how to manage the patient during cardiopulmonary bypass, Johnson was 'chomping-at-the-bit' to do a case or two of his own.  Today he got to do his first Kenyan open heart entirely on his own (with me at his side).

The perfusion circuitry we were using during the adult cardiac week was completely different than any circuit he'd been exposed to in Nashville (soft-shell venous reservoir vs. the hard-shell venous reservoir systems), so he has been able to get a lot of great experiences prior to graduating that he otherwise would not have had.

Johnson was very attentive to patient management during the procedure as well as anticipating the needs of the surgeon and responding to the directions he received from the surgeons and anesthesia staff (and me).

The procedure was done on a 21 y/o patient who had a weakening in the wall of the aorta where the blood flow enters the left coronary (sinus of valsalva aneurysm).  This procedure is a very big procedure that requires cooling the patient down further than usual and removing the entire portion of the aorta, the large vessel that carries the blood out of the heart.  The circular structure you can look down into in this picture is an artificial aorta that was sewn in to replace the patient's native aorta.  The surgeon will eventually sew the open end of this graft to the patient's remaining aorta that has not been removed.

View of the OR team during the surgical procedure



The photo above is of Johnson weaning the patient off of bypass about 7 hours and 10 minutes after bypass began.  The patient was very very sick, but as things usually go at Tenwek, after we 'treated' the patient for about 12 hours in the OR, 'Jesus healed' him and he was extubated and sitting up in bed the following morning.  It was a truly amazing day in the OR and the patient continued to do well and was discharged from the post-op ICU within a couple of days.