This morning, Patty visited with Dr. Cziperle (zipper-lee), yet another in a long line of doctors with unusual but oddly profession-appropriate names. A previous surgeon involved in Patty's care had the surname Slaughter (okay, not so much appropriate as ironic). Dr. Cziperle will be performing the insertion of Patty's HeartNet device early next Tuesday morning at Edward Hospital. PJ, Kelly and I went along to listen and to ask questions. I'm not sure we have all the details 100% correct, but I think we recalled enough to provide a general overview.
The doctor said that the procedure lasts approximately one hour from first cut to final stitching, with an extra half-hour of preparation before surgery. The prep includes a right heart catheterization (to measure pressures in the heart), a wrist catheterization (to measure blood pressure), an interior echo (down the throat, to visualize the heart) and an epidural catheter for pain management after the surgery. As to the latter, the surgeon explained that this pain is likely to be legendary (among the very worst), because of the sensitivity of large nerves that run along these ribs. In 95% of cases, this pain subsides over the course of several weeks; in the remaining 5%, this pain does not subside, ever, and the nerve endings have to be, for lack of a better word, killed. I'm not thrilled about the idea of Patty hurting like this, but the prospect hasn't scared her off, so you'll still find me at the front of her cheering section (I'll be the one with the deer-in-headlights look on my face).
The actual procedure, as we understand it, involves:
- placing a breathing tube down the throat
- collapsing the left lung (breathing is controlled and monitored by the anaesthesiologist)
- making an incision between two ribs somewhere on the lower left side (location to be determined by where the lower tip of the heart is found, which isn't a slam dunk because the tip of Patty's damaged heart may not be where one might expect to find it)
- making another incision, this time through the pericardium (the sac surrounding the heart)
- grabbing the tip of the heart using a suction device and pulling it into a more elongated (or correct) shape
- placing the HeartNet device (a special metal alloy mesh) around the lower part of the heart and releasing it in position so that it holds the shape it had been suctioned into
- making sure the device has no bunches or folds, which would require that it be taken off and replaced (not because Patty would have a problem it looking unflattering, as you might anticipate, but because it wouldn't function properly)
- reinflating the lung
- closing the incisions
- that's all, folks
If you'd like to see more about the procedure, a number of web sites have illustrations and/or news reports. Just Google "Paracor HeartNet" and you should find a bunch of stuff. Anything you read about the HeartNet-D, while really cool and just a little sci-fi, is irrelevant as far as Patty is concerned. Patty's just getting the garden variety mesh bag.
Patty will be in the cardiac intensive care unit (CCU) for 2-3 days after her surgery and, if all goes well, should be home within a week. While she's still in hospital, a drainage tube at the incision site will allow the lung to heal and drain effectively, and the epidural will be kept in place to control pain. After she's home, she will be restricted in her activities, including being barred from driving for a month, in part because of the side-to-side motion, and in part because she'll probably be stoned out of her gourd with pain meds.
Some of the more common risks of this procedure are infection, bleeding, air leaking from a lung and arrhythmias. Less common are more severe complications, including death (two cases in all study participants to date). The vast majority of participants have done very well, and most report significant improvements in quality of life (including measurable improvements in ejection fraction). Given Patty's relatively young age, we're hopeful she'll come out of this ready to run the Chicago Marathon, or at least extend her healthy years by a great many. Specifically, Patty's hope (and mine) is that this surgery will prevent the need for a transplant, ever. Dr. Cziperle agreed that this was a good goal, and suggested that it seemed much more possible with the device than without, although researchers only have two years of history with the device to measure successes and failures. The early results are very encouraging.
Edward Hospital has liberal visiting hours, even in the CCU, and I'm sure Patty will welcome company once she's out of the initial post-surgery groggies. However, you may want to check in advance on the condition of our patient, so that your visit doesn't involve an hour of watching Patty snore, snuffle and drool (I'll post pictures of this, anyway). If you don't have my cell number, send an email to firstname.lastname@example.org and I'll share it with you.
Please continue to keep Patty in your thoughts and prayers.