UnityPoint Health St. Luke's Hospital takes you inside the
heart for a triple bypass open heart surgery in Cedar Rapids,
Iowa. Our patient is Scott Frederick. He's a 54-year-old
Cedar Rapids man who had progressively struggled to
catch his breath. Initially, he thought his asthma was
gradually getting worse and went to an urgent care to get
checked. Once there, the doctor looked at his chest X-ray and
noticed his swollen legs and told him to go to the ER as he
suspected Frederick may have congestive heart failure. It
was confirmed at St. Luke's ER and Frederick received
unexpected news. He would need triple bypass surgery. I
couldn't even go up a flight of steps because just being so
short of breath and I thought what we both thought was
asthma. I was taking a couple different inhalers and wasn't
getting any relief. So yeah, so this is quite a deviation of
the highway going from asthma to open heart surgery. That's
kind of what led up to it is the fact that I had shortness
of breath and you know, had to sleep sitting up in my
recliner, couldn't eat much 'cuz I just feel like I bloated
the whole time to retain so much fluid. In the operating
room is Dr. Gary Weide, a cardiothoracic surgeon from
Physicians' Clinic of Iowa, an anesthesiologist, a
perfusionist who operates the heart and lung machine, a
physician assistant and St. Luke's highly-skilled open
heart team of nurses and surgical techs. You know, most
people with coronary disease or blocked arteries typically
present with chest pain and he surprisingly never had any
chest pain but for him, what ultimately happened is it was a
slow progressive thing where the blood flow to the heart was
reduced and the heart muscle just progressively got weaker
and weaker and weaker because it wasn't nourished with the
blood that it needed. So, as the heart pump started to
fatigue and fail, he started to build up a lot of fluid on his
lungs and in his legs and so, you know, that's how he
developed congestive heart failure. So, for him, it was
more of a progressive slow blockage thing as opposed to an
acute immediate thing, which we can see from time-to-time.
Congestive heart failure is a progressive condition, which
affects the functioning of the heart. It can be life
threatening if left untreated. So for him you know he's got
what seems to be a reversible cause in the fact he's got
coronary arteries and blocked arteries. Some people their
heart failure is related to valvular disease. If you
correct the valve either problem or replace the valve
you know the heart muscle typically if it's no longer
subject to the stress of either a faulty valve or have more and
more lack of blood flow. In time, the heart muscle will
ultimately recover. Now, some people the heart failure is
irreversible and it's damaged to the point that you can't fix
it. During open heart surgery, the heart is stopped and a
heart and lung machine is used while the surgeon works on the
stopped heart. For us to be able to operate an emotionless,
you know, virtually bloodless field. They put 'em on
cardiovascular bypass or heart lung machine so that requires us
putting in big tubes or big cannulas into the heart that
will drain blood and get blood back to the heart and then
ultimately what we do is we use a high potassium solution to
cause the heart to stop. So the heart now is no longer beating,
which allows us to work without the heart moving as we're
trying to do things. You know, during that time, we cool the
patients so that the heart's protected, the brain is
protected, the rest of the organs are protected and then
that gives us a chance to work for several minutes to try to
get accomplished when we need ultimately get done. As the
surgery gets underway, the patient's sternum or breastbone
is cut to allow access to the heart. The surgeon typically
works on harvesting what's called the internal mammary
artery of the front side of the chest plate. So, it allows us
to work of simultaneously so we can be, you know, productive
and we can be efficient through the operation. The biggest part
of coronary surgery or bypass surgery is you gotta have
conduit whether it's arteries or veins and so for us today
was an artery from the chest plate, two veins from the leg.
The surgeon works in tandem with the physician assistant to
harvest healthy blood vessels, which will be used to bypass
the blocked area. The harvesting of the vein left leg
historically or many many years ago, the way that was coming
through a large open incision down the inside part of the leg
and you would take this, you know, the greater saphenous vein
out and over the last though I would say 20, 25 years or so,
techniques and equipment has been developed to basically
make a small incision by the knee and you have a camera with
a little dissector on the end of it. You can kind of you
know, tunnel it up and down the leg to basically clear the vein
and free the vein up of the surrounding tissue so
ultimately you can just pull the vein out with only a small
incision by the knee and that's greatly improved any patient
comfort and patient satisfaction after surgery.
Once the surgery is complete, the beat is restored and the
patient is disconnected from the bypass machine. We're ready
to start the heart again. As I mentioned, the heart's been
cold for a period of time. The heart's got a lot of potassium
in it. So, we give basically warm blood. We call it a hot
shot. It's basically warm blood that's delivered directly to
the heart. It does two things. One is it washes out any
remaining potassium that's potentially circulating around
the heart muscle itself and the other thing it does is it warms
the heart up. You know, the heart doesn't like to be cold.
If the heart's cold, it doesn't beat very well. So it does the
ability to warm the heart up wash the potassium and
obviously take the clamp off ideally you want the heart to
start beating occasionally the heart isn't quite ready to
start beating again and and hearts that you know are sicker
than normal sick heart the heart defibrillate and so the
heart begins to fibrillate you gotta use these paddles that
defibrillator shock the heart to get it back. During the final
step in today's procedure wire is used to close the chest. And
when we're done everything make sure things you know hemostatic
nothing's bleeding fortunately for Scott everything seem to be
pretty secure nothing is bleeding and then you're
closing the chest. There's multiple ways to close the
chest. The most common way to close it is with surgical
stainless steel wires and so for Scott, you got a
combination of seven wires in total, a combination of single
and double wires. The double wires are just added for
protective strength so the bone can heal back together. It
takes typically about eight weeks for the bone to heal so
his wires are designed to hold the edges of the chest bone
together to allow the bone and body's ability to heal it for
its own strength forms. Following surgery, Frederick
spent two days in the intensive care unit and another four days
at St. Luke's. He immediately felt a difference in his
breathing. Frederick is participating in cardiac rehab
and likes that it helps him know his limits as he works
exercise back into his routine. Just me trying to be over the
aggressive but you know I'm thinking I can handle more
maybe a couple more minutes going on the machines or maybe
a little more weight when I'm lifting because it's I don't
feel taxed but then the nurse is telling me, well, you may
not feel taxed but that's not the muscles that you're working
that maybe tax. So, a lot of it's been education. Basically,
just kind of relearning what I need to do. Plus, there's also
this accountability factor too. Frederick is all looking beyond
his recovery to spending time outdoors, traveling to see his
adult children and catching a game at Wrigley. He's grateful
for his care at St. Luke's from the ER to the operating room to
the nursing care. Oh, I think it was exemplary. Everybody was
always asking about what he need, what could he use. I was
down from the the first year students that came from Coe to
the ones that have been here probably 30 years. So everybody
was going above and beyond especially during this time of
being so short staffed. UnityPoint Health - St. Luke's
Hospital is Cedar Rapids Heart Hospital as the area's leader
in open heart surgery since 1978. We invite you to learn
more about our program and St. Luke's Heart Care
Services today. UnityPoint Health, know how much you
matter to this world.