Stopping The Heart

[ALCapshaw]

I think Bill Aldridge is the only member (that I recall) who has addressed the issue of 'stopping the heart' and expressing his fear of that thought.

I've not read of any problems restarting the heart VR.com, but that doesn't mean that they don't occur in some small percentage of operations. Does anybody have any statistics on this issue? It's probably a good question to ask the Surgeons. With 98-99% success rates and other issues predominating the failures, failure to restart the heart must be way down the list of bad outcomes (my pumphead can't remember the proper medical words).

I expect most of us either put our heads in the sand and don't think about it or look at it like turning off our cars and fully expecting them to restart the next we want to go somewhere. Knowing dozens of survivors (and NO fatalities), I guess I never had much concern over the issue.

'AL'

 

[Nancy]

Hi Al-

I would imagine from time to time there are some hearts that need to have some TLC to restart. They really don't like the way they're treated in surgery, cut open, messed around with, strange things attached and all kinds of gadgets gumming up the works. Every surgeons must have had some course on Restarting the Heart 101. I would imagine that they do every kind of thing to help bad hearts from massaging them to shocking them. I think the desired outcome is to restart it.

 

[Christina]

Hi Al,

I've known someone who's heart did not re-start after surgery. I never met her personally but only knew her over the phone. She was an aunt of one of my customers and terrified to go into surgery. She called me numerous times to talk before her big day, and I tried to ease her mind by telling her she'd do fine.
What I did not know was that she had been an avid smoker up until two years before surgery. The heart was very damaged by the smoking the surgeon told the family. She had the same surgeon who did my surgery.
When the heart did not want to re-start after surgery they put her on an artificial heart for a few days to let her own heart heal, but even after 5 days her heart didn't re-start, they let her go. She was 70 years old.
This was all I was told by the family niece.


Christina
AVR's 8/7/00 & 8/18/00
St. Jude's Mechanical
Dr. Gulshan Sethi
Tucson, AZ

 

[hensylee]

Al, I don't really think we view our hearts as being actually stopped - guess we feel that the pump is the 'heart' while they are doing stuff to the heart. Not a real pleasant thought, is it?

 

[wlaldridge]

Yes, I put the term "stop my beating heart" in much of what I talked about. I was really much more worried about some of the serious downside risks which I refuse to list here. But being a pilot and flight instructor with some contact with pumps and machines, I know that shuting down a perfectly good engine (when you will need it soon) is not a GOOD thing. I have had the experience more than once and it can be a near heart stopping event in and of itself. Sorry for the puns that insist on asserting themselves into my posts.

I did not and do not take lightly the shutdown/restart process for mission critical components. But, some of the other downside probabilities are more unsettling. It is not for fun that they are working so hard on "beating heart" techniques. Just not highly likely when the valves are to be replaced.

Good point tho AL.

See ya,

Bill

 

[Bill Hall]

Al - Good subject. In my case, they did have a difficult time restarting my heart. When in the ICU, I noticed the large circular imprint on the side of my chest (about 8 inches in diameter) where they shocked my heart to get it started. That fact has not bothered me to date, except it will be a factor if I ever need re-surgery.

 

[queenie61]

While we're on the subject of fears, I'm most afraid that they won't have the right size valve for me. All my life Dr's have said everything I have is too small. What if the valve is too big? Is this silly? My surgery is one month from today and I've chosen a mechanical. One size doesn't fit all. Queenie

 

[ALCapshaw]

Hi Queenie,

Sounds like a good question for your surgeon. I know the St. Jude valves are made in several sizes but don't know the range or exact sizes. ASK. I would expect they have the full range available during surgery. The surgeon doesn't want to have to wait for someone to go find another size!

'AL'

 

[hensylee]

Didn't someone else have a problem with wrong size valve not long ago? My pumphead won't let me recall the exact details - but it did get worked out.

 

[gary]

Size of valve:

Size of valve:

Considering the 'narrowing' effects in the outflow tract of nearly all artificial valves, from the ring sewed to the annulus of the aortic wall in tissue valves, to the obstructions of many mechanical valves IF your aorta is in good shape, an 'oversized' valve is peferred for implant to compensate for some of the loss of area.

Mine was changed from it's estimated aperture of 23 to 25 millimeters, the exact size of a 25 cent piece. My surgeon told me just before lights out that he would try a slightly larger valve if he was convinced my aorta could handle it.

You may experience the same thing. I'd certainly ask that question, which I had never considered in the runup to my surgery.

 

[ALCapshaw]

Bill,

Are you SURE they used paddles to 'jump start' your heart in the CICU? You mentioned only ONE mark, not two. The paddles I've seen are rectangular, not round, and no where near 8 inches long.
Did you ask what caused your mark and why there aren't two?

Another point, when you are in the CICU, you should still have pacemaker wires attached to your heart. Aren't those wires for the purpose of 'jump starting' the heart in case it doesn't start on it's own? If the pacemaker wires are still in place, I don't see the need for external paddles.

'AL'

 

[Bill Hall]

Al - Thanks for responding. I don't really have much true information, except that they did have difficulty starting my heart and that there was a large circular imprint on the side of my chest (only one). It was much larger than the one they used to cardiovert my afib heart. I did have the external wires, but I thought they were to give your heart a shock if it missed beats. I am guessing that they needed more power to get me started (sounds like a dead battery, huh).

 

[hensylee]

Yesterday in HEARTCENTERonline there was an article telling about NOT stopping the heart during by-pass surgery. It is new and so far successful and in the 'learning curve' at present. So, if they will be using it for bypass, can valve replacement be far behind. Sounded like very good news.

 

[wlaldridge]

It would be nice if they could do the valve job without stopping. I don't think it is very likely in the present form. Bypass surgery really doesn't involve the same components (only arteries suppling various parts of the heart itself), components of the heart critical to the pumping(namely the check valves that prevent back flow) have to be removed in order to replace them. The heart can not be in pumping mode to do that.

Sort of like, if you have a well supplying water to your house. A circuit can be shut down to repair or install new use points with out shuting down the pump. But if the pump has to be worked on itself water will have to be shut off in the house unless a spare pump can be installed to keep the house running(like the heart lung machine does while the heart is stopped)

I think, but miracles are being performed daily and who knows what some clever person will come up with.

Bill