Hi, my name is Duc Thinh Pham.
I'm a cardiac surgeon at Bluhm Cardiovascular Institute
of Northwestern Medicine.
Today, we'll be performing a heart transplant
in a patient who will, despite a lot of medical therapy,
he's developed end-stage heart failure,
and today we've been lucky to find a heart for him.
So please join me in the operating room
as we perform a heart transplant
using the TransMedics Organ Care System.
[♪♪♪]
Right now, the anesthesia team is getting our patient ready
with putting him to sleep, and behind the scenes
at the other hospital, my partner Ben Bryner
is picking up his new heart.
In the past, the typical way of transporting a donor heart,
would be the use of a simple cooler system on ice.
The new TransMedic Organ Care System
allows us to take the heart out of the donor body,
then reanimate it,
allowing it to receive oxygen and nutrition
while we bring it back here to our hospital.
And it also has allowed our team to transport the heart
longer distances and for longer periods of time.
With the old cooler system,
we typically would have about four to six hours
from removal of the heart from the donor
and then putting it back into our recipient.
With this new system, we can go as long as 12 to 24 hours.
So I just got this video from Dr. Bryner
who's already connected to the TransMedic Organ Care System,
receiving blood through that pump.
You can see it beating vigorously already.
-Looks like a great heart.
-[cell phone rings]
-Hey, Ben.
-We're at the airport.
We'll leave in about 12 minutes.
All right sounds good.
Safe travels.
-All right, thanks.
-Thanks.
The limited amount of time
that the heart's outside of the body,
there are a lot of touch points.
From not just evaluating the heart,
but then, when the heart comes out of the donor body,
when the team is leaving the donor hospital,
when they're taking off,
and so, each step of the way
I'm timing what we are doing here,
so that we are primed and ready
for when the team arrives with a new heart.
So while we're waiting for this team to come back
with the new heart, I'll be getting started on our end.
That'll consist of forming an incision through the sternum
and then getting the patient ready by connecting him
to the heart-lung machine.
When we know that the team is back safely
here at Northwestern, we will then be able
to start cutting out the old, sick heart.
I'm just marking the incision here just to orient you.
Once again, the patient's head is over here to my left.
Knife, please, thank you.
Starting incision.
So, I'm about to saw through the sternum with this saw here.
It's just like a power tool, an oscillating saw.
Lung down.
[saw whirring]
And now the sternum, the breastbone has been divided.
So, our patient, he has hypertrophic cardiomyopathy,
which is a thickening of the muscle of the heart.
His heart doesn't relax and open up well.
So, the amount of blood that it fills with is limited.
So even though his heartbeat's fine,
it doesn't eject enough blood flow
to satisfy the demands of the rest of his body.
He was sick enough that he required to be in the hospital,
and he also needed the assistance
of the intra-aortic balloon pump,
the device that actually sits inside his aorta
and it helps decrease the pressure
the heart has to beat against.
When somebody requires a pump like that
while they're on the transplant list,
they're given what's called status-2,
which is the second highest priority
for patients waiting for a heart transplant.
Typically, those are patients who we are concerned
that without a heart,
their life expectancy may not be
much more than a couple of months.
[cell phone rings]
-[nurse] Hello.
-Hey, it's Bryner.
-We just landed.
-Okay, they've landed.
All right.
So, Dr. Bryner and the procurement team
should be coming into the OR pretty soon.
And the timing is just right.
We're cutting out the left atrium,
the back, for the last chamber of the heart.
Here's his old heart.
I want to send that off to the pathology lab.
-Hey, how are you?
-Doing good, how are you?
-[Duc] Perfect timing.
-[Bryner] Good.
We just took out the old heart.
So, the heart looks really good on this device.
It's pumping really nicely.
Okay, so now we're gonna cool the heart down
and re-arrest it so that it's ready
to get thrown into the recipient.
During transplant, when we reanimate it,
we needed warm blood, but to re-arrest it,
we have to cool it to sort of decrease the metabolic demand.
And then we're giving it a solution that will stop it
from functioning.
And then, once that happens,
we'll disconnect it, bring it to the back table,
do some final prep, and then start implanting it.
As I'm putting these hearts in,
I'm looking at the size of the recipient vessels.
Sometimes they are a lot larger than the donor vessels.
So I have to correct any size mismatch.
So that way there's no narrowing once we're done.
I wish it could be as easy as plug-and-play.
But these aren't custom-made for each other.
We have to make this work.
Scissors, please.
That'll line up okay there.
Hold that.
[indistinct]
Let's cut this a little bit shorter.
We're onto our last one.
Alright, so we're done with the last suture line.
We're about to take the clamp off.
When we do that, the heart's going to start
seeing blood again.
But before that,
we're gonna nudge it along
by giving it a little bit of warm blood.
Um, what we call "hot shot",
because the heart has been somewhat cold.
And we don't want to shock it too much
by suddenly giving it warm blood.
High power, please.
This heart just gave a little twitch,
even that small, little bit of warm blood.
That means that the heart's already starting to wake up.
All right, we're gonna take off the clamp here,
and now the heart is going to see the same blood
that the rest of the body has been seeing
throughout this case.
When I see the heart
start beating on its own, it's a good sign that that heart's,
you know, coming up to life.
It's happy.
Especially, when it happens almost immediately.
I'm pretty sure at that point
that this heart is gonna do really well.
I just got a good look at how well the heart's squeezing
with just a little bit of volume in it.
And I'm pretty happy with it.
We're gonna start weening the heart-lung machine.
Function looks great.
I wanna go and give the family a call.
Hi, it's Dr. Pham.
I wanted to give you the good news.
We finished with the heart transplant.
We got a great heart for him.
It's pumping really nicely.
It's pumping on all its own.
So, we're off the heart-lung machine.
I'm super happy with the way things look.
We're gonna take another hour or so,
and then we'll be getting him to the intensive care unit.
We're off to a great start.
You get your rest,
and I'll see you later today.
All right.
Take care.
Bye.
[♪♪♪]
Thank you for joining us in the operating room today.
The team here worked hard for last couple of days
coordinating this transplant.
Dr. Bryner and the procurement team
traveled a good distance and brought us back a good heart.
It's working great.
The patient's doing well.
I anticipate one or two weeks here in the hospital
and then he'll be going home to his family.
Thank you for joining us in the operating room.
[♪♪♪]