He opened the sternum, quickly stopped the bleeding, and exposed the surgical field. Zheng Ren found that, as expected, the adhesion in the mediastinum was very heavy.
The second surgery was like this. After the first surgery, the human body would have fibrous connective tissue proliferation, changing the normal physiological anatomical structure.
Looking at the messy tissue inside, Zhao Yunlong felt a headache coming on.
The elephant nose surgery itself was the biggest surgery in the cardiothoracic surgery department, and the second stage of the elephant nose surgery …
Difficulty x10!
Zheng Ren reached out and patted the hemostatic forceps and blunt scissors on his hand.
Lao He glanced at it and felt that it would take at least a few minutes to open the aorta. This was still Boss Zheng's chief surgeon. If it were anyone else, it would take at least 30 to 60 minutes to successfully swim to the aorta bow.
He took out the USB flash drive, quickly found the audio file, and clicked on the song "Good Luck".
The familiar and melodious music sounded, but this time, Su Yun did not complain. It was as if he did not hear that the background music had changed at all. He was focused on cooperating with Zheng Ren's wandering.
The two hemostatic forceps flew up and down. It was very beautiful.
The blunt scissors moved away, and the sound of the ultrasonic knife rang out.
"Prepare for heparinization," Zheng Ren said in a deep voice as he moved away.
Lao He was a little surprised by Boss Zheng's confidence. Heparinization did not take long. Usually, heparinization was only carried out after the surgical area was prepared.
Boss Zheng was very confident in his movement. He estimated the time and asked for heparinization early in the morning.
Lao He began to prepare calmly while paying attention to the progress of the surgery.
After 3 '12 ″, the aortic arch appeared in the surgical field.
He separated the aortic arch and its branches and put them on separately.
"Heparinization is complete."
The moment Zheng Ren put it on, Lao He said.
The timing was just right. Lao He knew that it was not that he had cooperated well, but that Boss Zheng had an extremely accurate assessment of his level.
If the medical team was a machine, he was just a component. Boss Zheng had long understood the level of his skill and calculated it into the surgical process.
It looked like the seamless cooperation was actually the embodiment of Boss Zheng's calculation ability. Lao He only sighed but did not continue thinking about it.
The surgery was still progressing at high speed, so he could not afford to be distracted.
After heparinization, Zheng Ren inserted the 24F artery into the right subclavian artery 2 ~
3cm。 He did not dare to insert it too deeply because if the tube was too deep, it would enter the nameless artery and seriously affect the brain perfusion.
Then the right atrial or superior or inferior vena cava was intubated.
"Full flow transfer and cooling down."
There was only one person speaking in the operating theater. The quiet atmosphere in the operating theater indirectly proved the difficulty of this surgery.
The oxygenated blood was supplied to the whole body from the right subclavian artery through the innominate artery to the aorta. The retrograde perfusion tube was inserted blindly through the right atrium.
"Report nasopharyngeal temperature."
“35℃。”
“33℃。”
“30℃。”
“27℃。”
When nasopharyngeal temperature drops to 26 ~
At 28 ℃, the ascending aorta was blocked and cold-blooded cardioplegia was perfused through the coronary sinus.
While continuing to cool down, he completed the lesion exploration, prosthetic valve replacement, proximal artificial blood vessel anastomosis, and coronary artery anastomosis during coronary artery bypass grafting.
Zheng Ren moved quickly, but the more he probed, the more anxious Su Yun became.
Marfan syndrome was a congenital disease. After the ascending aorta valve replacement and coronary artery transplantation two years ago, the patient's local changes were so great that it exceeded the original expectations.
The adhesion was very strong. Let's not talk about that first. The appearance of a bubble in the middle of the anastomosis indicated the possibility of an interlayer.
Does the surgery have to be done together with the primary bypass?
Even Su Yun was caught unprepared by this situation, and had a headache.
When he saw the situation of the operating area, he raised his eyes and glanced at Zheng Ren.
Zheng Ren's emotions did not seem to change at all as he performed the surgery calmly.
Su Yun felt a little more at ease. With the boss around, what was there to be afraid of?
"22 ℃." Lao He continued to report the temperature.
"20 °," Zheng Ren said.
The two of them were talking about completely different concepts. Old He reported the temperature of the nasopharynx. It was a key point that had to be paid attention to during the surgery of deep hypothermia and circulatory arrest.
The 20 ° that Zheng Ren mentioned was the angle at which the patient's head was lowered. After Zheng Ren finished speaking, the three of them stopped the surgery at the same time. Lao He began to adjust the angle of the operating table.
Head down at a 20 ° angle.
He then proceeded to block the innominate artery, left common carotid artery and left subclavian artery, reducing the arterial flow to 8ml.
/
Kg ·
At the same time, the ascending aorta occlusion forceps were opened and the aortic arch and descending aortic arch surgery was started.
"20 ℃." Lao He was still focused on reporting the temperature.
This temperature was the horn for the start of the general attack.
After Lao He reported the temperature, Zheng Ren immediately blocked the ascending aorta. The aortic root was cold and the heart stopped beating.
"Ice slurry."
The prepared ice slurry was sent to Zheng Ren's hand.
Zheng Ren tried it first. There was ice and water, 4 degrees Celsius. There were no large pieces of ice. All of them were small pieces of ice that could cool down the heart as quickly as possible.
For general heart surgery, being able to make this kind of perfect ice slurry could at least increase the completion rate of the surgery by a few percentage points.
This was a detail, but it was an indispensable detail.
Zheng Ren was very satisfied. He placed ice slurry on the surface of the heart to cool it down.
The nasopharyngeal temperature dropped to 18 degrees Celsius.
Zheng Ren began to block the aortic arch 3.
Brachiocephalic blood vessels, extracorporeal circulation arterial perfusion flow changed to 6 ml/(kg · min)
Selective anterograde cerebral perfusion was performed at 10 ml/kg · min.
The aortic arch was cut along the long axis of the aortic arch. The proximal side was to the original artificial blood vessel anastomosis, and the distal side was to the proximal end of the left subclavian vein opening.
Because the heart had stopped beating, the deep hypothermia cardiopulmonary bypass had been established, so when the aortic arch was opened, no blood flowed out.
The aortic arch was clean, and the operative view was clear.
The purpose of deep hypothermic circulatory arrest was for this moment, and now it seemed to be almost perfect.
"Pay attention to the amount of blood clots in the brain." As Zheng Ren cut open the aortic arch, he said in a deep voice, "If Old He isn't familiar with it, turn the screen 22 ° to the side. I'll watch."
Lao He was a little ashamed. This should have been the anesthesiologist's job.
However, he was in the middle of a surgery and had just come into contact with a new machine. He did not have the time to familiarize himself with it, understand it, and familiarize himself with it.
He did not hesitate to do as Boss Zheng said. The ultrasound probe was placed on both sides of the patient's neck. It did not affect the position of the surgery or the head. The screen was facing Boss Zheng, and countless data was floating on it.
The amount of data made Lao He helpless.
This should be a product of the laboratory, and it was still in its early stages. There was still a need for a computer to do precise calculations and output the results.
But now, there was no final result. Countless data signals appeared on the screen like snowflakes.
From time to time, Zheng Ren looked up at the color Doppler ultrasound screen, but his hands did not stop moving.
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