The doctors began by prepping the patient's body, sterilizing the entire chest. They made an incision around the parasternal border in the 5th or 6th intercostal space (not entirely sure). After cutting through all the layers and finding the pericardial sac, they used some sort of mechanical apparatus to ply apart the ribs and create a larger opening to perform the surgery.
For ease of surgery, the physicians performed many small tasks to facilitate the bypass. The left lung was intentionally deflated to prevent compression and obstruction of the heart. Once the LIMA was located, they cauterized all surrounding branches and tied a red traction band to the artery. This traction band allows easier tracing of the artery and facilitates its resection. When the time came to cut into the pericardial sac, the surgeons opened the sac carefully and sewed the membrane to the chest wall. This prevents the pericardial membrane from falling behind the heart and also keeps a wide view angle of the problematic area. Afterwards to further position the heart, the surgeons stuffed sterile gauze behind the heart to push it forward as well as rotate it for a better view of the LAD.
The intense part came afterward when they had to stabilize a beating heart to sew the LIMA onto the LAD. They used some horseshoe shaped tool that had suction cups along the "U" shape to stabilize the heart. However, when they tried to hook up the two arteries, they realized the LIMA wasn't long enough to attach to the LAD. To resolve this issue, they removed part of the great saphenous vein in the right thigh to connect to the LAD and LIMA.
At Touro, we learned that there is a debate about whether these procedures should be performed on a stopped or beating heart, but one of the physicians there explained some criteria to choose beating/stopped heart procedures. Operations for a stopped heart are usually because of the number of vessels involved, right coronary artery, and patient condition/status.
Of all the surgeries I have witnessed, I think I learned the most from this one and also, solidified a lot of prior information learned in class.
To top off this awesome day, I was allowed to scrub up and wear a sterile gown/gloves for a different surgery. One of the doctors there taught me how to sterilize my arms and "suit up" for surgery. I was at the table as a laproscopic check up was done on a stab wound patient. The atmosphere of being right next to the patient and just being a far away observer was extremely different. The view was amazing and I felt really alive, for lack of a better word. Before as an observer, I was always a few feet away and honestly, got tired and bored once in awhile. However, while I was AT the table, I don't think I have been more focused and awake in a long time. Everything was a new experience and I was just really grateful to get this chance.
This entire day really opened my eyes to surgery and I am definitely a lot more interested in pursuing it in the future.
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