Week 7

This week was my final week of immersion, and I have to say I wish that we had at least a couple more weeks here! I spent a significant portion of my time working on the new research project that I mentioned last week in my blog, and was able to get some results. Shown below in Figure 1 are some of the preliminary results of PCI, CABG, and all cardiac surgery caseloads from 1994-2015. In Dr. Tranbaugh and Dr. Ko’s original paper through year 2008, the number of PCI procedures had risen steadily each year, with a small dip between 2007 and 2008 (Ko et al., 2012). It is now clear that the small dip observed before was actually the beginning of a decline in PCI procedures, as shown in Figure 1. Additionally, CABG case numbers have steadily declined throughout the 21-year time period until around 2012, where they appear to have somewhat plateaued. Dr. Tranbaugh said that we can probably submit this and some of the other data I have to a journal whose abstract deadline is in August, and I am very excited!

Figure 1. PCI, CABG, and all-surgery number of cases in New York State from 1994-2015

Procedure-wise, this week I saw a TEVAR, which stands for thoracic endovascular aortic repair. This procedure is performed to repair aneurysms in the aorta minimally-invasively. To repair the aneurysm, a collapsed vascular graft is attached to a catheter, and is threaded into the femoral artery through a large incision in the groin. The collapsed vascular graft is positioned into the location of the aneurysm, and inflated with a balloon into place. For the patient that I saw, the aneurysm was in the descending aorta and was so large it required multiple vascular grafts. A serious complication of this surgery is blocked perfusion to the spinal cord due to the vascular graft, which can result in paralysis of the patient. Unfortunately, the surgeons cannot know whether this has happened until the patient wakes up and tries to move their legs, which seems very stressful and scary to me. Luckily, everything seemed to go according to plan during the surgery.

As it is my last day, I wanted to comment on some overall lessons that I have learned during my immersion term:

1.       Teamwork is essential for physicians. Every surgery has a plan, and everyone implicitly knows what the plan is from start to finish. Also, everyone in the OR seems to have a heightened awareness at all times. If surgery and lab research were sports, I would say surgery is like hockey or basketball, with the surgeon as playmaker, while lab research is like long-distance swimming or track.

2.       All physicians are constantly on their toes, and are able to make decisions in a split second. Even though there is always a plan for every surgery, the plan can change instantly. As someone who is generally a slow decision maker, it was so impressive to see the physicians draw on a multitude of knowledge that they have on-hand at any given moment and make the best decision.

3.       Cardiothoracic surgeons practice and practice their surgeries hundreds of times, until it appears that each procedure is almost second nature. I can see how it could be difficult to implement a new technology surgically as an engineer, because the new technology must be so good that it outweighs the expertise and years of practice that the surgeon has in performing their procedures the conventional way.

4.       There is rarely a dull moment in cardiac surgery! Every week, I was able to see at least one cardiac procedure, if not multiple. This highlights that there is still a widespread need for new cardiovascular disease treatments.  However, it is important to note that from my research, the overall number of PCI and CABG procedures is declining as of 2015. Dr. Tranbaugh speculated that this could be due to improved medical care of patients with coronary artery disease that may have otherwise progressed to surgical patients.

Everyone at the hospital was so sweet to me on my last day in the office at NYPBMH. One of the administrators that I have been working with to set up my immersion paperwork, Anand, ordered a pizza and ice cream cake and everyone got together and ate with me for my last day. I have been so lucky to have such an amazing opportunity to work with Dr. Tranbaugh, Dr. Worku, and everyone in the CT surgery department at NYPBMH, and am certainly going to miss working here. Dr. Tranbaugh was a wonderful teacher, and really made this summer an amazing experience. I feel grateful for all of the surgeries that I have been able to observe, all of the knowledge that Dr. Tranbaugh has given me about general surgical procedures, anatomy, and surgical device development and history, and all of the research I have been able to do with the CT team this summer. I am really going to miss the people, the experiences, and the city when I return to Ithaca tomorrow, and am sad to go.

Source:

Ko, W., Tranbaugh, R., Marmur, J. D., Supino, P. G., & Borer, J. S. (2012). Myocardial revascularization in new york state: Variations in the PCI‐to‐CABG ratio and their implications. Journal of the American Heart Association, 1(2), e001446-n/a. doi:10.1161/JAHA.112.001446