Last night, I had a very unusual and yet utterly fascinating experience – watching an open-heart surgery being carried out live. The surgery was carried out at Papworth Hospital, and then broadcast over a satellite feed to a couple of auditoriums at the Wellcome Collection in central London.
The Wellcome Collection is the public arm of the Wellcome charity, which spends around £500 million a year funding medical research. It is the world’s second largest charity – behind the Bill and Melinda Gates Foundation. As part of their public outreach program, the Collection linked up with the hospital to show the general public a live major surgery. This was the second time they have done this, the first time being earlier in the year – and the popularity indicates that they are keen to repeat the session.
While it is not uncommon for a major surgery to be broadcast to another auditorium, it is usually for medical students or to demonstrate a new procedure to other surgeons. To show it to the general public -and as a live broadcast – is very rare.
Anyhow, I had a couple of tickets (they “sold out” within a couple of days) and arrived to the very plush auditorium.
I am appalling with names, so I can’t recall the names of the people involved, but a quick Google hunt reminds me of their names (I hope!). We had an opening speech from the Wellcome Collection manager, and he then handed over to a surgeon who was in the auditorium, Samer Nashef who explained what was going to happen.
We then had the video link to the hospital, and were introduced to the surgeon there, Francis Wells who would lead the operation and his staff in the operating theatre. Francis Wells is one of the world’s leading experts in the type of surgery we were about to see. I was not aware before the event of the high calibre of the people we would be seeing.
The patient was an anon man in his late 70’s and had a faulty heart valve which they were going to try and repair.
We got to see the initial incisions – then the screen went blank. This was deliberate as they felt that if they showed the cracking open of the chest wall (hammer and chisel) then the packed auditorium would be significantly less full afterwards 🙂
While that rather gory process was going on, Samer in London explained a bit about how the heart works and how the valve in question functions and what has gone wrong. It is possibly important to comment that the patient was not ill due to lifestyle choices. His ailment had probably been there since birth and after a lifetime of effort, the muscle had simply worn out and a defect that was always there finally became apparent.
Francis in the surgery came back on the screen now that the chest wall was fully open and we could see the beating heart at work.
I think it is important to explain a certain disconnection with the human on the table. We never saw the person – just a hole surrounded by fabric coverings and then lots of action going on. That lack of connection with the fact that there was a real person on the table made it oddly a lot easier to watch. Had they had a naked man on the slab, with a huge gaping hole in his chest – then it could have been more emotionally difficult to deal with.
Having exposed the heart (and cleaning up some surrounding areas) the next stage was to insert pipes into the main arteries so that the blood could by bypassed from the heart and keep the patient alive. Here was a slight icky moment oddly – as when one pipe was inserted a lot of blood gushed up for a moment, and it did feel a bit grisly to see the life-blood flowing away like that.
They suck away all the blood that escapes and try to reuse as much of it as possible, returning it to the patient throughout the operation.
Anyhow, once the bypass was ready and they had cleared the pipes and tubes out of the way to make things neater – they stopped the heart. That was done simply by pouring a quantity of potassium loaded cold saline over the heart which stops the electrical process – and the heart simply seemed to fall asleep. There was no big trauma or shocks, it just fell asleep. Fascinating to see.
Throughout the evening, the audience were able to ask questions of both surgeons as a microphone was passed around – and the two surgeons bounced between each other explaining issues as they were raised. They also kept up a running commentary throughout the operation to explain what they were doing, and what we were looking at.
Anyhow, now that the heart was stopped, they could get on with the operation which is to attach a couple of cords to the valve to reattach it to the muscle. I won’t detail that as it is easy to see, but difficult to explain in text form.
In total, I think the actual repair took about 15 minutes – but it took nearly an hour to open the body and prepare the heart to get to that point.
Once the repair was done, and tested – it became very evident how the repair had improved things – he started to reverse back out of the body, undoing the process he had completed only a short while earlier.
Once back out of the heart and the bypass was removed, there was a slight issue with restarting the heart. Through its own processes as it was getting blood again the electrical pulses were working again – but the heart was not beating but just vibrating. This is the fibrillation that a defibrillator is designed to fix. They slipped a couple of “lollypops” onto each side of the heart and applied a couple of shocks and suddenly the heart just swapped from vibrating to beating normally. Again – an amazing thing to see happen live in front of us. The body didn’t bounce up as you see with normal heart shocks – I guess because they were able to apply a much smaller voltage directly to the heart.
The final stages are handed over to the nurses as the work is not complex and Francis came to one side to finish off the talk and we finished with a round of applause, just before the satellite feed was lost.
It was an oddly emotional experience, and one I can’t convey in a simple blog posting – you really do need to watch the event to appreciate it. I think some of it might be available later as the Guardian were there with cameras as were the BBC doing some filming (alas, I was a bit of a scruff!) so maybe you will get to see on telly what I saw live in the auditorium.
I guess the TV can’t broadcast the operation live just in case the patient dies. There is about a 1% mortality rate for this operation.
I found out about the event from the Wellcome Collection mailing list – and if you are interested in this, I would recommend signing up for that to be told about possible future events like this – and their other events.
As a final note – grateful thanks to the anonymous man who agreed to have his operation shown to the general public like this.
Update – The BBC did cover this and also uploaded a short (2.5 mins) video which shows just a small sample of what we saw that night.