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Restarting the Heart after On-Pump Heart Surgery - LewisGale Regional Health System

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- Interesting, you know, you see people on these shows,

they get the paddles and they go (exclaims),

and they give them the power, (laughter)

and then the heart starts beating again, right?

The perception is that the electricity

shocks the heart into beating.

That's not the case at all.

The electricity stops the heart.

That's the whole idea of electricity.

It completely depolarizes the heart,

so there's no activity whatsoever.

And then from that quiescent state,

the natural pacemaker of the heart picks up

and starts beating again, okay?

So that's what you're doing

when you're cardioverting somebody.

You're taking this chaotic rhythm, wiping it out,

and resetting the heart and letting it start fresh.

And so the same thing with open-heart surgery,

when the heart is on pump and quiescent, it's not beating.

You let the blood back in, it starts beating again,

it just starts as if you had defibrillated it.

It just starts.

So it used to be when I first started this 30 years ago,

for every minute that we'd been on ...

That we'd stop the heart, we allowed the heart

to reperfuse, to be without supporting life for two minutes,

which meant that our bypass times were incredibly long.

Our operations were like six hours,

and there was absolutely no reason for that.

There was absolutely no reason and now,

the heart starts beating, we're done,

we come off pump within a minute and it's done.

- Things have changed, too, because you go back in time,

let me just back up a little bit, too.

When we're getting ready to stop the heart,

we cross clamp the aorta and we give a solution

called cardioplegia to the heart.

It's a high potassium cold buffered solution and so,

what that does, and it's mixed with blood,

but what it does is, the high potassium, it stops the heart

and actually cools it down so there's

less energy being utilized.

And so when we come back off the heart,

getting ready to come back off,

we take the aorta cross clamp off and so,

regular blood perfuses into the coronary arteries

and it just starts beating on its own typically.

And so the interesting thing also that people don't realize,

the myocardial muscle cells in a Petri dish

will start beating

and the pacemaker of the heart coordinates the beating,

so that's actually a muscle that'll start beating.

- And there's no storage of energy in the muscle.

It beats as strong as it can given the blood source it has.

So there's no benefit to letting the muscle

beat without working for 10 or 15 minutes.

Within a minute or so after the blood comes in,

the muscle's as strong as it ever was.

- That's true and I think things have changed, too.

We used to cool down, cool the patient all the way down.

Our times are so fast now, we don't really even

cool the patient down. - We don't have time.

We don't have time to cool down anymore.

- So what happens is when the heart starts beating,

we would have to take a long time rewarming the patient,

and we don't cool ...

We cool the heart muscle down,

but we don't really cool the patient down as much anymore,

so it doesn't take us as long.

- I think with a well trained team

and people that worked together for a long time,

these days you can easily do a three vessel bypass

in three hours I would think.

- Or less, yeah. - Yeah.

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