Mercer Island MD explains Dave Ross’ heart surgery

There are now about a half million open heart surgeries in the United States every year. As of three weeks ago, KIRO Radio’s Dave Ross is one of those heart surgery patients.

Dave is still recovering from his surgery, but brought Dr. Gordon Cohen, MD, onto the show to explain what happened when his heart was stopped and restarted.

As someone who’s done this many times, Dave asked Dr. Cohen when he comes to the point that he’s operated on the heart and done the bypass — or, in Dave’s case, taken out the tumor — and it’s time to start the heart up again, what is that moment like?

“It’s a pretty surreal moment,” Cohen said. “… The whole process of heart surgery is pretty interesting. So how do you stop the heart and keep somebody alive? Well, it wasn’t even possible until the 1950s with the heart lung machine, and what the heart lung machine does is it does exactly as it sounds. It does the work of the heart. It does the work of the lungs.”

“So we actually hook the patient up to this machine and we take the blue blood, the blood without oxygen, away from the heart. And that’s the venous blood. And we run it through the machine, through the pump, which works as an artificial lung. That’s the lung part of heart lung, and it exchanges gas, it makes the blood red. It puts oxygen on the cells and takes carbon dioxide off the cells, and then it pumps the blood out to the body the way your heart was doing,” Cohen explained.

When someone is on that machine, they don’t need their heart anymore.

“So we can actually stop the heart,” Dr. Cohen said. “And we do that by depriving the heart of blood. Then we instill a solution down the coronary arteries, and that solution is rich in potassium.”

The potassium stops your heart, he explained, and once that happens, the doctors can do whatever they need to do to the heart, whether it’s to fix things inside, replace valves, or remove tumors.

“Once that’s done, we then have to take the clamp off and re-perfuse or bring blood back to the heart muscle itself,” Cohen said. “And every time it happens and you watch the heart restart, it’s sort of surreal that you have stopped the heart and it restarts.”

“But you know what? It starts virtually 100% of the time,” he said. “And that’s because the heart is really designed, as an organ, it’s designed to beat and it wants to beat. And if we weren’t giving it this solution to keep the heart stopped, it would beat. And, frankly, even when we have it stopped and we were depriving it of blood, if we don’t repeatedly give that solution, the heart will start to beat again anyway.”

Dr. Cohen has been practicing cardiac surgery for more than 25 years and says he is still amazed by the heart every time.

“The whole experience is sort of surreal and it never gets old,” he said.

As far as recovery, it tends to take months more so than weeks.

“I do think we’ve gotten better at understanding that,” Dr. Cohen said about recovery. “I do think we have pushed patients more over time. I think we used to let patients convalesce in the hospital for quite a long time and we would keep them on limited activity.”

“But we’ve learned that the shorter amount of time you spend in the hospital, the more you have a patient act like a person and less like a patient, the better they will do,” he said.

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