Page 20 - ANZCP GAZETTE DECEMBER 2023

10:00
After some minor dissection, the surgeon cross-clamps the heart and you deliver the final two bags of heart preservation fluid as cardioplegia under pressure- control via a pressure-bag. You mark the cross-clamp time stamp, and mentally start the ischaemic timer on the donor heart. With the heart explanted and moved to a sterile table, the surgeon begins securing the cuff of the self de-airing aortic cannula. You open the sterile draping contained in the heart box, exposing the open reservoir where the heart will be suspended. The surgeon connects the heart to the rig, you circulate through the recirculating line to allow the cannula to de-air. You then commence pressure-regulated perfusion of the donor heart. You notice something strange – in order to reach the driving pressure of 20mmHg, flow through the roller pump is upwards of 800ml/min. Since the flow matches an open recirculating priming flow, you assume full aortic incompetence. A quick discussion with the surgeon has them repositioning and re-seating the heart. Resumed flow has dropped to a much more reasonable 180ml/min and you’re both happy. Looks like the other procurement teams will still be a while, but you bid your farewell as it’s time to get out of dodge.
11:30
As you drive back to the airfield, you ponder whether utilising the XVIVO Heart Box means you should be pausing the ischaemic timer?
Before boarding the plane, you do your last-minute checks. Down to the last quarter cylinder of carbogen, not really interested in doing a fiddly plane gas bottle exchange, you decide to swap now. Being a pressure- locked connection, you have to turn the cylinder off and warn your team to ignore the impending alarms as you wait for the gas in the line to purge so you can unscrew and change it. With that done, you reload the plane and off you go! The pilots even sourced you a platter of sandwiches and fruit for lunch. And yes, I will also have that coffee if you don’t mind.
15:30
Not much to do on the plane but recall the time you were procuring a heart in the Gold Coast - declared a COVID-19 hotspot mid-procedure and if we deigned to board the flight back to Melbourne, there would be police waiting on the tarmac. No police, but an apologetic Mark Mennen in full n95 gear on the tarmac with explicit instructions to receive the heart box but to leave me behind. Five days of isolation, daily phone calls from the hospital COO and an eventual federal cabinet meeting later, and we were out of isolation. Let’s hope this procurement is less eventful.
Some turbulence coming back into Melbourne has you catching the fruit platter mid-air, thankful for the 30° tilt alarm on the heart box. After a safe landing, you load into the taxis and head back to the mothership.
17 DECEMBER 2023 | www.anzcp.org