Mediziniche Hotschule Part III

After eating lunch in the hospital cafeteria, we were invited to watch the LVAD implant for a patient we had met in the morning, the patient suffering from total body edema.  This patient was in extremely poor condition.  Dr. Hanke told us he was a candidate for a bivad, because both sides of his heart were relatively insufficient.  He elected to receive only an LVAD as his right heart, although less than satisfactory, was still functional enough to pump blood through the pulmonary system.  Because the patient was in such bad shape, the procedure was a dangerous one.  For this reason, we watched the procedure from the edge of the room, and couldn’t see what the surgeon was doing.  Luckily, I was generally able to understand what was going on.  The patient first had to be put on a heart lung machine since his heart would have to be stopped in order to attach the VAD, so he was arterially and venously cannulated.  His heart was then stopped, and the VAD was sutured to the ventricle and attached via tubing to the aorta.  Next, the VAD was activated and the patient was very slowly weened off the heart lung device.  The transition from the heart lung device to the VAD must be slow in order for the patient’s heart to get used to the VAD continuously circulating the blood.  If the surgeon transitions too quickly, the patient’s heart will fail and the patient will die.  After the source of circulation was successfully transitioned, the patient was sutured up and moved to ICU to begin a long recovery.

                Upon the end of the surgery we made our way back to ward 15, and very graciously thanked Dr. Schmitto and Dr. Hanke for being our mentors for the day.  They gave us their cards and told us to contact them if we thought of any more questions and to let them know if we ever wanted to go back.  As a momento Dr. Hanke gave us a manual to the HeartMate II, the VAD device she had taught us all about earlier that day.  Although some parts were rather dry, the chapter regarding the implantation procedure was very interesting, and provided me with entertainment for the train ride all the way back to Bonn.  Overall, the trip was extremely enlightening, and it honestly convinced and motivated me to continue my long pursuit to becoming the best cardiovascular surgeon I can be. 

From left to right: Dr. Schmitto, Carlos, myself, Dr. Hanke