Surgery Godfather
Chapter 1218 - 944: The Engine that Stopped_2

Chapter 1218: Chapter 944: The Engine that Stopped_2

Liang Fatty couldn’t help but sigh; girls really are difficult to please. Ever since his school days, every girl he pursued ended in failure. The reasons they couldn’t be together were all different. Some thought he wasn’t handsome enough, others that he didn’t have money. Now that he had money, his girlfriend complained that he didn’t have time. Does making money not take time?

If he were tall, rich, and handsome with plenty of free time, would he even need a steady girlfriend?

Men, oh! It’s tough!

"Don’t space out, focus up."

In the midst of busyness, Zhou Can took a moment to remind the distracted Liang Fatty.

Liang Fatty nodded; Zhou Can was rather understanding. Knowing that Liang Fatty had been troubled these days, she not only comforted him but also took him to the movies to relax and advised him on how to be tolerant and cheer up a girl. After all, every girl hopes to spend more time with their loved one.

One must be serious at work and not let their mind wander; even Liang Fatty understood this simple truth. He had just been accurately calculating the patient’s anesthesia dosage in his head.

Zhou Can went up to the operating table to arrange the instruments, a skill she had learned from Xiao Su. Following Xiao Su every day and with extensive surgical practice, Zhou Can naturally mastered the preparation for many of the leading-edge operations, executing the duties of an instrumental nurse to perfection.

Per Xiao Su’s requirements, Zhou Can not only learned how to use the instruments but also mastered their design principles and the history of their invention as well. She also grasped the entire history of surgery, the whole surgical process, every detail, understanding why and how to use each instrument at every step of the operation.

Qiu Nuo joined Zhou Can on the operating table, observing her organizing the instruments and silently memorizing the order in which they were laid out.

The division of instruments on this operating table was noticeably different from the traditional arrangement. Each instrument had been meticulously organized through practical experience, and even Qiu Nuo, who worked at Xiehe Hospital, had never seen such a scientifically arranged setup of surgical instruments.

As Zhou Can deftly arranged the instruments, she explained to Qiu Nuo why they were set up in that way and topped it off with, "This is all taught to me by Sister Xiao Su."

It was Xiao Su again; alright, she would call her "sister" from now on, even though Qiu Nuo was a few months older than Xiao Su.

The patient from Sweden was already positioned correctly; Xia Shu, with a graduate student, began disinfecting and laying the drapes, and Yang Ping decided to have Xia Shu act as the first assistant.

A heart surgery team often consists of surgeons, anesthesiologists, extracorporeal circulation perfusionists, and nurses. No role is dispensable; everyone must assist each other to complete such sophisticated operations.

Some hospitals that want to poach top cardiac surgeons often need to take the whole set, poaching the entire support team, as just taking the chief surgeon often fails to form a combat-effective force.

Doctor Yu, the extracorporeal circulation perfusionist from Sanbo Hospital, was busily preparing. He had not gone elsewhere for further training and had grown entirely through the heart surgeries at Sanbo. Previously unnoticed, he was gradually coming into prominence.

The extracorporeal circulation team is an indispensable auxiliary team for heart operations because the human heart beats continuously, and the presence of blood and the pumping heart can affect the surgeon’s field of vision and precision during surgery. The goal of extracorporeal circulation is to maintain the blood supply to the body’s peripheral organs while the heart is stopped during the operation, with a machine oxygenating the blood to maintain the supply to all tissue organs.

It’s just like repairing a car’s engine; it must first be turned off and stopped. The logic is the same.

With the advancement of surgical technology, techniques for performing surgery on a beating heart have also been developed, like coronary bypass surgery without stopping the heart.

All beating-heart surgeries have a premise—they do not require opening the heart. For example, coronary bypass surgery doesn’t require completely opening the heart; it’s merely a matter of working on the surface or within the myocardium, similar to running indoor piping without having to break through an entire wall.

Some operations mandate fully opening the heart, and during those times, beating-heart techniques cannot be used; the heart must be stopped.

It’s quite simple, if the heart doesn’t stop functioning, once it’s opened, the blood inside the heart will gush out. This not only makes the surgery unoperable, but for the human body, it’s the ultimate hemorrhage; the body will quickly die from blood loss.

The specific operation of extracorporeal circulation involves drawing blood outside of the body, processing it through a specialized machine where the blood undergoes oxygenation, gas exchange, and filtration before being reinfused into the body. The purpose of this is to interrupt the heart’s blood flow, making it easier for the surgeons to perform direct vision operations within the heart, ensuring a clear surgical field while still maintaining blood perfusion throughout the body to preserve entire organism survival.

In fact, the extracorporeal circulation machine serves as a temporary substitute for a person’s heart and lungs, sharing the same principle as ECMO (extracorporeal membrane oxygenation).

ECMO, fully named extracorporeal membrane oxygenation, is actually a longer-duration technique of extracorporeal circulation. As the technology of extracorporeal circulation can only substitute temporarily for a few hours during surgery, ECMO can be used for longer periods, generally from 7 to 30 days. Currently, the world record for the longest use of ECMO is 605 days.

The principle of ECMO is to use a blood pump to replace the heart and a membrane lung to replace the lungs, continuously transporting blood to the body to maintain blood supply to all organs and sustain life, thereby achieving long-term substitution of heart and lung functions.

The extracorporeal circulation system used in heart surgery is also called an artificial heart-lung machine. It is a system that can temporarily substitute the functions of the heart and lungs, and its structure includes an artificial heart, artificial lung, temperature regulator, blood reservoir, ultrafilter, and so on.

The artificial heart consists of several pumps that replace the heart in pumping blood; the artificial lung’s function is to add oxygen to the blood. Oxygenated blood flows through the body and returns to the artificial lung, where carbon dioxide is expelled.

The temperature regulator adjusts the temperature of the blood to make it suitable for the body and the needs of the surgery.

The blood reservoir contains filters and defoaming devices, used for storing preload fluids, intracardiac return blood, etc.

The filter removes air bubbles, platelet clots, fibrin, fat droplets, silicone emboli, and minute tissue fragments that have shed, so they don’t enter the blood circulation.

Monitoring devices primarily observe changes in vital indicators, such as arterial blood pressure, heart rate, oxygen saturation, coronary artery perfusion pressure, and blood gas electrolytes, etc.

These structures work together precisely to form an artificial heart-lung machine that temporarily substitutes the heart and the lungs during surgery, allowing all the body’s blood to bypass the heart, leaving the heart free for the surgeons to operate on.

After sterilization and pre-surgery verification, Yang Ping began the surgery.

Incising the skin, opening the chest, exposing the pericardium, revealing the heart, aorta, and the superior and inferior vena cava.

Yang Ping inserted cannulae into the aorta and the superior and inferior vena cava and had the perfusionist connect the cannulas to the extracorporeal circulation machine. By doing this, the entire body’s blood circulation bypassed the heart and lungs, with the machine replacing the function of the heart and lungs. Extracorporeal circulation officially began, and Dr. Yu closely monitored every piece of data on the monitoring devices, constantly communicating with the anesthesiologist, Liang Fatty. The two coordinated with each other to adjust the patient’s vital signs to the safest and most suitable state for surgery.

Dr. Zhao adjusted the machine’s temperature regulator to lower the temperature of the blood to achieve the goal of lowering the patient’s overall body temperature.

Artificial circulation had been established; the heart could now be stopped. Starting from the root of the aorta, Yang Ping injected arresting solution into the heart through the left and right coronary artery openings, causing the heart to gradually cease beating under the influence of this special solution. After the heart had completely stopped beating, Yang Ping then cut open the heart.

The hood was open, the engine was off; now they could open the engine to see what was actually going on inside.

Inside, it was indeed a mess, with an abundance of overgrowths attached to the previously replaced aortic and mitral valves. Bacteria had severely eroded these valves and their attachments, devastating the previous surgery to a point beyond recognition. This not only nullified the original surgery’s effect but also destroyed the foundation for any remedial work, and the infection was the source of the systemic spread.

Although the patient’s heart was in cardiac arrest and the lungs had also stopped functioning, life was still vibrant. At this moment, life was entirely sustained by the perfusionist sitting there and the machine beside him.

If the machine stops, the patient’s life stops; if the machine runs, the patient’s life persists.

At this moment, Liang Fatty had no distractions in his mind; all his thoughts were focused on the patient undergoing surgery. He constantly watched the data on the monitoring devices and communicated with the perfusionist to analyze any fluctuations in the data and eliminate potential hidden dangers.

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