Immediately after revival of the heart; ischemic signs(ST elevation) due to three-hour long ischemic time, non-pulsating BP by CPB(cardio-pulmonary bypass).

The best Sunday I have ever had :) A heart transplant surgery! I have been feeling I shall not die before seeing it :)

The best moment is, of course, the transplanted heart starts to beat again!! That is amazing. The heart was under arrest when it arrived, and it was re-perfused in coronary artery and wash-out several times to avoid reperfusion injury, remove the air to avoid air embolism by tilting the operating table up and down and giving massaging, voila, it revives!

• Patient:
  
  • Ischemic Heart Failure + congestion.
  • Ejection fraction: 16%. (End stage Heart Failure)
  • The heart is dilated. Pulmonary edema(by congestion) too.

• Donor:
  • 21 year old.
  • Car Accident -> Brain death.
  • The heart looks really healthy.

• Procedures:
  5 sutures(standard).
  1. left atrium
  2. inf. vena cava
  3. sup. vena cava
  4. pulmonary artery
  5. ascending aorta.
  The suture was done in this order.

• Results:
  • Total Ischemic time: 3:05
  • 14:00 Donor aorta clamp.
  • 17:05 release of aortic clamp in recipient.

Photo from immediately after revival of the heart. ECG has ischemic signs(ST elevation), of course, due to a 3 hours ischemic time. Also the heart beated against no afterload and a flat fashion not pulsating fashion, because CPB(cardio-pulmonary bypass) is still working; the new heart needs warm-up and get used to a new "place" ;) We waited 1 hour for reperfusion and then we were decreasing CPB work gradually and then stops the machine eventually, then the heart works fully on its own and BP becomes pulsating.

Removal of the recipient heart is done without cardioplesia(without stopping it), so it beated for a while even after it is removed from the chest cavity. The removed heart will be used for research of heart failure.

The assistant cardiac-surgeon was a friend of mine since he was still a medical student. He now is a doctor and resident; He did a quite good job, that was also nice to know.

Added: Heart rate is in tachycardia range; it is because all innervation is cut because of HTX(transplant). And it goes to tachypnea, which indicates our hearts is relatively parasympathetic dominant and once it is cut heart rate is increased. The screen's tachycardia is due to dobutamine and epinephrine for operation, but it stays over 100(tachycardia range) one week later when I checked. There were 3 HTX patients, all three are the same.

The other important note is pain innervation is cut too, which means there would be no pain even in myocardiac infarction like in neuropathy by DM, which is very dangerous. Luckly this pain innervation is sometimes regenerated; my tutor said it is not uncommon :)