2/5/16

                 There isn't a lot to report for today. After a very packed valve conference, Dr. Nguyen went into surgery (at around 9:30, and I had to leave at 10:20)- so I stuck with his PA for the remaining amount of time that I was there. She filled me in on the surgery that Dr. Nguyen was to perform: Valve Sparing Aortic Root Replacement. I like to call it VSARR, because that rolls off the tongue more easily, but it is also known as a David procedure. It's a pretty interesting surgery, and is quite long. If an aneurysm (air bubble) occurs in the aorta, this surgery is done to remove the aortic root, which is the area right above the aortic valve. The aorta gets clamped shut, the heart gets cooled, and the patient is put on a heart bypass machine for the duration of the surgery. Because the aortic root is so close to the coronary arteries and the aortic valve, it's hard to remove the root without doing some additional work- so, the coronary openings are detached from the aortic root, to be reattached later. This is when the aortic graft comes in. Sutures attach this piece to the aortic annulus, a structure that rings the aortic valve, and the ascending aorta above that. Finally, the coronary arteries are reattached through small holes in the graft. Variations of this surgery exist, including one that removes the aortic valve, even if there is nothing wrong with it (though, that isn't really VSARR, because it doesn't spare the valve).  That specific variation is known as the Bentall Procedure. If a patient is a candidate for the David procedure, but has some aortic valve complications, they might as well go through the Bentall procedure to kill two birds with one stone. This is one of the more complicated surgeries I've learned about, although I'm sure that there are some I don't know about that are even more intricate. I really do learn something new every day that I'm here. 

P.S., just to give a visual of what I was explaining: