Week 1: Hitting the ground running

Week 1: Hitting the ground running

This week, I started my summer immersion program with Dr. Tranbaugh. It has been a very exciting start- I have already seen surgical procedures and had some exposure in the clinic.

For part of the week, Dr. Tranbaugh had me shadow his physician assistant. One patient we saw had an arterial dissection, which is when the lumen of the artery separates and forms a subcavity where blood can flow. I also saw a patient with Dr. Tranbaugh who was recovering from an infection at a healing surgical site. The technique to avoid scarring and promote healing in wound sites such as these is called “wet to dry” and involves adding a wet gauze to the wound site, and removing and replacing it once it becomes dry. Additionally, we saw a patient who had a patent foramen ovale (PFO). A PFO is a developmental deformation where the hole that connects the right and left atrium during fetal development does not close after birth. A bubble test is typically used to diagnose PFO. This test injects microbubbles into a vein so they travel to the right atrium, and observes whether bubbles are able to transpire through the PFO to the left atrium. If there is a hole, bubbles will pass through to the other side of the heart, but if there is no hole, the bubbles go to the lungs and are released.

In the catheter lab at the hospital, I was able to see a TAVR, which stands for transcatheter aortic valve replacement. For this procedure, a stent-like artificial valve is opened in the native aortic valve and expanded to pinch the native valve to the walls of the vessel. The artificial valve is expanded into place using a balloon. Once the catheter was set up in the patient, the procedure was surprisingly quick.

I was also able to see coronary bypass surgery, which was the most exciting part of the week! This week’s coronary bypass procedure used autografts exclusively. Before the procedure started, both radial arteries were extracted from each of the patient’s arms, as well as the saphenous vein. The grafts were sealed where there were branching vessels with small metal clips that reminded me of staples. Once these grafts were extracted, it was time to open the chest and begin the open-heart part of the coronary bypass.

To reach the heart, all the muscle, skin, connective tissue, bone, and anything else in the pathway of the heart must be cut. All of this was quite bloody, and Dr. Tranbaugh said this is because patients who need coronary bypass are usually on blood thinners to reduce hypertension. Once the cavity was open, Dr. Tranbaugh used what looked like a jack to mechanically pry apart the two sides of the chest. Then, he did not begin the bypass surgery, but rather extracted the left mammary artery.

Finally, it was time to start the bypass. The heart was stopped, and five bypasses were performed. The patient was attached to a heart-lung machine, which oxygenates the patient’s blood and returns it to circulation. This machine is crucial to sustaining the patient during CABG (coronary artery bypass grafting) surgery. I saw most of the surgery, but left as the OR team was draining the cavity to finish the surgery.

Overall, this week has been a whirlwind! I was able to see so many amazing procedures and meet many clinicians and staff at NYPBMH. It seems that I will be starting my research project more in depth soon, and I am excited to see what the next week has in store.