A Day in the Life of a Cardiac Surgeon

It's 6:30 in the morning. We are in the parking lot of the East Tower of Robert Wood Johnson University Hospital. It's Friday, which is my normal operative day, and today we'll be doing four operative cases. Good morning Dr. Lee, how are you? Three of the cases are minimally invasive cases and one case is a coronary artery bypass. So COVID has really impacted the way we do things every day. Obviously, we all wear masks all day, every day, not just in the operating room. Some of the contact that takes place after surgery is by telephone. Tomorrow. Patients in the room.

Once we connect the patient to the monitors, we do what is called a timeout, which is a safety check. Alright, time out. The time-out process we do in the operating room comes from the World Health Organization and is a way to be very careful and make sure we don't make mistakes. This woman is 62 years old and has what is called aortic stenosis. The valve at the top of the heart, called the aortic valve, has become very narrow over time and, as a result, her heart has to work harder to try to push blood through that tight valve.

When all the blood cannot move forward, it starts to back up and returns to the lungs and causes difficulty breathing. It can also cause chest pain because the heart is working too hard. It can also cause lightheadedness because not enough blood actually escapes from the heart to the brain. So what we're doing today is what's called a minimally invasive aortic valve replacement. To keep everything else in the heart in good working order, you will have an incision about three inches on the right side of the chest, where we go between the ribs and that's where we can go in and then replace the valve.

Okay, you can ventilate both lungs. It's pretty simple that everything went well as expected. So I'll just call the family member. Hello. Good morning, this is Dr. Lee calling from Robert Wood. Good morning Dr. Lee. We are all done with surgery. All went well. They replaced the valve through a small incision on his right side. She is fine. This is great news. Thank you so much. She's fine, see you a little later, okay. Okay, have a good day. As a

surgeon

we receive a lot of credit. But honestly, surgery is 10-15% of the success of our program.

It's all these people. It's everyone in this room, it's everyone in the ICU, it's everyone on the floor. The care they provide, the attention to detail, all of that is incredibly important to success. It's already nine o'clock, we are in the second room. This man is 74 years old and, like the last patient, has a tight aortic valve. But on top of that, because this has been going on for a long time, the mitral valve is now leaking as well. So he's in very good shape, a 74-year-old gentleman, so obviously we're going to go ahead and fix his heart.

We will do this again through a small incision on the right side of him. We'll go in to replace the aortic valve and repair the mitral valve. So, using ultrasound or ultrasound, we can see that the valve is actually... the mitral valve is actually calcified. So you may need to replace both valves in this circumstance, but we'll see what that looks like when we get in. We are a very high volume center and the importance of high volume is that there are many studies that show that the more you do, the better you will be and you will become an important reference center.

But that doesn't take away from the personal touches we have with our patients and the personal relationships we have with our patients. How are you doing? He is good! Is he? Yes, everything went well. He replaced both valves with a small incision in the side. Otherwise, his heart is in good shape. He will be out of the operating room in about 20 minutes. When you can go out and talk to the family and tell them that everything went well and that their loved one is okay, it's always very, very rewarding, and that's one of the best parts of the job.

The next patient is a pure mitral valve. That is the valve in the middle of the heart and in your case it has a considerable leak. Just like all of these other valve problems we've seen today, if this is left alone and not fixed long term, the heart begins to grow and weaken, grow and weaken. Is the aortic valve okay? This is the main teaching hospital for the Rutgers Robert Wood Johnson Medical School. We are all medical school professors and this is where we practice. We do approximately 1,600 hearts per year, which is one of the largest programs in the Northeast.

One. And the right. The right is totaled. Okay, so four. Well. Four ring roads. We just arrived in the room with the fourth case, which is a coronary artery bypass. And what we do with bypass surgery is the only operation today that we're actually doing using a standard approach. They will make an incision right in the middle of your chest. We will take an artery from inside the left chest and some vein from his legs to bypass it to the heart. We don't touch the blockages, we leave them where they are and use this artery and veins to bypass the blockages so the blood can get to where it needs to go.

Are you OK? We are ok. Thank you. Thank my Lord. Calm down. Thank you all. From here we will go up to the ICU. Make some rounds for the patients we operated on today. We are the largest academic medical center in New Jersey. How are you? We do a lot of research in

cardiac

surgery. I have a laboratory   as well as clinical research. Is it okay to last a few more years? He is good, yes. It is an institution that has students, residents, research, education and ideal or optimal clinical care that encompasses all treatment modalities for forward-thinking patients.

And we want to be in that innovation with a vision of the future. This is how our day ends. It's around 4:10 right now. So we've solved all our cases, we've seen all our patients, and I think it's time to go home.